2009 Mulligan

DOES ATTITUDE AFFECT RISK?
An Investigation into the Potential for User Acceptance of

Computer-based Interactive Monitoring Systems (CIMS) in the
Management of Musculoskeletal Disorders in the Workplace
Jan Mulligan
Project report submitted in part fulfilment of the requirements for the degree of
Master of Science (Human-Computer Interaction with Ergonomics) in the Faculty
of Life Sciences, University College London, 2009.
NOTE BY THE UNIVERSITY
This project report is submitted as an examination paper. No responsibility can be

held by London University for the accuracy or completeness of the material therein.
Acknowledgements
I would like to thank my supervisors Rachel Benedyk and Nadia Berthouze for
their advice and support throughout this study.
My thanks go to the participants, who gave generously of their time. The study
would not have been possible without them. Thanks also to Kerstin Frank for her
technical skills and patience as I prepared my CIMS Acceptance Model.
Thank you to my friends and family for their constant support and good wishes.
Last, but by no means least, my profound thanks go to VCS whose unwavering

support and encouragement sparked a year of very hard work and long hours
culminating in this thesis. Thank you.
ii
Abstract
Despite high numbers of UK workers experiencing work-related musculoskeletal

and stress-related disorders, current legislation and intervention practices do
little to stem the tide of these conditions. Studies have shown that work-based
computer users need regular support in order to comply with MSD prevention
programs, such as those that promote work rest and stretch breaks. Successful
implementation of health and safety programs requires collaboration.
Traditionally, that has meant employers, employees and professionals (e.g.
ergonomists, occupational health officers, health and safety representatives)
working together towards a common goal, such as the reduction and prevention
of computer-related ill health. With the user-centred approach taken by Human
Computer Interaction, persuasive technologies may now play a part in the
collaborative venture.
The study investigates work-based computer users‟ attitudes towards

prospective persuasive technology, namely multi-factorial computer-based
interactive monitoring systems (CIMS). Working with the user, multi-factorial
CIMS should identify the physical, psychological and psychosocial factors that
contribute to work-related musculoskeletal disorders. User attitude influences
potential user acceptance (welcome, tolerate or rejection) of CIMS. A CIMS User
Acceptance Model is presented by which potential barriers to acceptance may
be considered, and where necessary addressed, in order for the individual to
make an informed decision whether or not to become a CIMS user.
By understanding what acceptance means to potential users, employers and

technology developers may gain greater insight into the needs and wishes of
users and so inform management strategies and/or future design.
iii
Table of Contents
Chapter Description Page
1 Introduction 1
1.1 The Nature of Work Related Musculoskeletal 1

Disorders
1.1.1 Defining MSDs 1
1.1.2 Risk Factors 2
1.1.3 Physical Factors 2
1.1.4 Psychosocial and Psychological Factors 4
1.2 Management of MSDs 5

1.2.1 Workplace Legislation 5
1.2.2 The Individual‟s Responsibility 6
1.2.3 Intervention 7
1.3 The Study 8

1.3.1 Background 8
1.3.2 Review of Persuasive Technology 8
1.3.2.1 Technology and Emotion Recognition 9
1.3.2.2 Ergonomics and Posture Monitoring 10
1.3.3 Computer-based Interactive Monitoring Systems 12
(CIMS)
2 Methodology 14
2.1 Stage 1 (Survey) 14
2.2 Stage 2 (Interviews) 16

2.2.1 Thematic Analysis 17
2.3 Conventions 18
3 Analysis and Findings 19
3.1 Stage 1 (Survey) 19

3.1.1 Section 1: General 19
3.1.2 Section 2: Symptoms 20
3.1.3 Section 3: Designing For User Need 22
3.1.4 Final comments 24
3.2 Stage 2 (Interview) 24

3.2.1 Word Lists 24
3.2.2 Themes 26
iv
3.2.3 Trust 28
3.2.3.1 Trust in Technology 28
3.2.3.2 Trust in the System (emotion recognition versus 28
posture recognition)
3.2.3.3 Trust in the Employer 30
3.2.4 Purpose 31
3.2.5 Choice and Control (Autonomy) 32
3.2.6 Privacy 33
3.2.7 Self 34
3.2.8 Perception of Risk 34
3.3 Validation 35
3.3.1 Stage 1 (Survey) 35
3.3.2 Stage 2 (Interview) 35
4 Discussion 36
4.1 Ethics in Persuasive Technology 36
4.2 Trust 37
4.2.1 Trust in Technology 37
4.2.2 Trust in CIMS Methods 38
4.2.3 Trust in the Employer 38
4.3 Purpose 39
4.3.1 Consultation 39
4.3.2 CIMS as an Emotion-state Changer 40
4.3.3 CIMS as a Social Actor 40
4.4 Autonomy 40
4.4.1 Choice 40
4.4.2 Control 41
4.5 Privacy 41
4.6 Self (the “user”) 43
4.7. The CIMS User Acceptance Model 44
4.8 Study Limitations 48

4.8.1 Self-reports 48
4.8.2 Project Timing, Participation and the Potential for 48
Bias
4.8.3 Stage 1 (Survey) 48
4.8.4 Stage 2 (Interview) 48
4.8.5 The Hypothetical Nature of CIMS 49
4.9. Future Studies 49

4.9.1 Potential Bias 49
4.9.1.1 Gender 49
4.9.1.2 Industry Sector 49
v
4.9.2 Adaptations of CIMS and the User Acceptance 50
Model
4.9.3 Applying the Model to Other Persuasive 50
Technologies
4.9.4 The Employer‟s Viewpoint 50
5 Conclusion 51
6 References 53
Figures Page
Figure_1 A conceptual framework of the possible roles and 3

influences that various factors may play in the
development of musculoskeletal disorders
Based on Figure ES1 from National Research Council,
2001 (p.3)
Figure_2 Overview of Captology 9

(Stanford University Persuasive Technology Lab, 2009)
Figure_3 Tension Taker (Ultrasis) 10
Figure_4 Word Grid used for Interview Questions A1, C and G 17
Figure_5 Response distribution for Survey Question 27: 21

“Which of the following statements describe(s) your
symptoms”
Figure_6 Response distribution for Survey Question 28: 21

“Which area(s) bother you”
Figure_7 Response distribution for Survey Questions 35, 36 and 23

37: “Would you welcome (35), tolerate (36) or reject (37)
any of the following detection methods”
Figure_8 Word cloud depicting dominance of responses to IQ-A1: 25

“If you experience symptoms whilst working (or as a
result of working), e.g. stress, headaches, eyestrain,
physical discomfort, how/what does that make you feel?”
Figure_9 Convergence of ethics, persuasion and technology 36

(Berdichevsky and Neuenschwander, 1999)
Figure_10 CIMS User Acceptance Model 47
Figure_11 Persuasive Technology User Acceptance Variables 50

vi
Tables Page
Table_1 Primary DSE Regulations 5

(Statutory Instrument 2792, 1992)
Table_2 Definition of a DSE Workstation 5

(Health and Safety Executive, 2002)
Table_3 Example Break Reminder Software Utilities 12
Table_4 Example Computer-based Interactive Monitoring Systems 15

(CIMS)
Table_5 Phases of Thematic Analysis 18

(Braun and Clarke, 2006)
Table_6 Abbreviation Conventions Used in Paper 18
Table_7 Demographic Characteristics: gender, age, industry 19
Table_8 Analysis of feedback from Survey Question 14: “What 20

might be the longest length of time you spend working at
your computer before taking a break, i.e. short break
away from the computer for telephone calls, paperwork,
filing, photocopying, comfort break?”
Table_9 Ranked positions for Survey Question 29: 22

“Please indicate which area(s) bothers you MOST”
Table_10 Ranked positions for the Survey Question 38: “From 24

those methods which you would either WELCOME or
TOLERATE, which detection method would you find
MOST acceptable?”
Table_11 Themes and Sub-themes Identified From Interview 27

Transcripts
Table_12 Trust Ranking Positions for Example Monitoring Systems 29

from IQ-J2
Table_13 Stage of Change Model Definitions 45

(Whysall et al, 2007)
Table_14 Examples of readiness states for CIMS 45
Table_15 Components of the CIMS User Acceptance Model 47
vii
Appendices Page
Appendix_1 Invitation to Participate in Research Project Survey 64
Appendix_2 MSc Human Computer Interaction Research Project 66

Survey (questionnaire), contains copy of the project
“Information Sheet”
Appendix_3 Interview Participant Informed Consent Form 84
Appendix_4 Example Questions for Semi-structured Interview 86
Appendix_5 Contact Sheet of Photographs Used During Interviews 96
Appendix_6 Survey Comments 100
Appendix_7 Interview Participants‟ Trust Ranking of Example 104

CIMS
viii
1. Introduction
It is estimated that 2.1 million people in the United Kingdom (UK) are suffering
from “an illness they believed was caused or made worse by their current or past
work” (Health and Safety Executive, 2009). Just over two thirds of that figure
may be accounted for by musculoskeletal disorders (539,000) and stress,
depression or anxiety (442,000). Work-related ill health is not a new
phenomenon. In the 18th century Bernardino Ramazzini, credited as being the
founder of occupational medicine, extensively documented work-related ill
health. When observing scribes and considering their related disorders
Ramazzini reported:
“…. certain morbid affections gradually arise….. from some

particular posture of the limbs or unnatural movements of the body
called for while they work”
(Cordiner et al. 1998, p.6-2).
Despite awareness of these issues for over three centuries, individuals continue
to experience work-related musculoskeletal disorders and stress-related ill
health. This study considers ways in which contributing factors, such as emotion
state, work habits and ill-advised postures adopted by work-based computer
users, today‟s scribes, may be detected. It also considers some of the barriers
that exist to prevent individuals taking advantage of related interventions.
This chapter introduces the reader to musculoskeletal disorders, their causes

and current workplace approaches to prevention. It explains how advances in
technology may be used to detect and manage the risks, which may cause or
aggravate such disorders, before presenting the study‟s focus: the potential use
of Computer-based Interactive Monitoring Systems in the battle against work-
related musculoskeletal disorders.
1.1 The Nature of Work Related Musculoskeletal Disorders
As Ramazzini (1713a) observed, work-related ill health may be multidimensional

in nature:
“The maladies that affect the clerks aforesaid arise from three
causes. First, constant sitting, secondly, the incessant movement
of the hand and always in the same direction, thirdly, the strain on
the mind from the effort ......”.
1.1.1 Defining MSDs
Repetitive Strain Injury (RSI) is a recognisable term to most office workers. RSI
has two classifications: Type 1 and Type 2. Type 1 RSI refers to well defined,
diagnosable conditions such as carpal tunnel syndrome (pain and compression
in the wrist) and tendonitis (inflammation of a tendon). Repetitive tasks can
cause these conditions, but they are not the exclusive cause. Type 2 RSI refers
J. E. Mulligan MSc HCI-E Thesis Page 1

to symptoms that do not have measurable signs of inflammation, muscle and/or
tendon damage or nerve function limitation, and so do not fit within known
conditions. As Type 1 RSI diagnoses are referred to by the name of the specific
syndrome, the term RSI has generally been adopted to describe Type 2
conditions, which may also be referred to as “non-specific pain syndrome” or
“diffuse RSI”. (NHS, 2007).
The lack of a clear diagnosis/definition for diffuse RSI means that the term is
interchangeable with others: Occupational Overuse Syndrome (OOS),
Cumulative Trauma Disorder (CTD), Upper Limb Disorder (ULD), which relates
specifically to the upper body, and Musculoskeletal Disorders (MSD) that may
affect the muscles, tendons, ligaments, nerves or other soft tissues and joints in
any part of the body. The HSE differentiates MSDs from other terms as the
symptoms may occur outside of the work environment and then be made worse
by work (Health and Safety Executive, 2007a). Where symptoms are attributable
to the workplace, the term “work-related” may be added, e.g. WRMSD.
1.1.2 Risk Factors
The high level of MSDS reported by the HSE (2009) may be partly explained by
their being influenced by biomechanical, psychological and/or psychosocial
factors (Armstrong et al, 1993; Turk, 1993) and as such have a greater number
of potential causes. Armstrong et al proposed a conceptual model for work-
related neck and upper-limb MSDs that is based on sets of cascading exposure,
dose, capacity and response variables, such that “response at one level can act
as dose at the next” (Armstrong et al, 1993).
Conceptual frameworks developed by the National Research Council illustrate

factors and physiological pathways that potentially contribute to MSDs. Figure_1
shows the Council‟s adapted version of its original framework. The arrows
between “The Workplace” and the “The Person” boxes indicate research
disciplines that have attempted to explain load-tolerance relationships, such as
physiology, biomechanics, and epidemiology (National Research Council, 2001,
p3). Psychosocial risk factors are also associated with or can predict change in
musculoskeletal health (Parkes et al, 2005). Devereux et al (2002) found that
workers highly exposed to both physical and psychosocial workplace risk factors
were more likely to report MSD symptoms than those highly exposed to one or
the other.
1.1.3 Physical Factors
Since Ramazzini, researchers have considered the correlation of posture to

health. Contributing factors to MSDs may include: posture; force, strength,
reach; anthropometric mismatches; prior injury; repetition, motion, duration of
exposure, dynamic and static load (National Research Council, 2001; Pheasant
and Haslegrave, 2006; Bridger, 2009).

The Workplace The Person
Biomechanical Loading
External Internal Loads
Loads
Physiological Responses
Individual Factors*
Internal Tolerances
Mechanical Strain
Organizational
Factors
Fatigue
Outcomes
Pain / Discomfort
Social
Context
Impairment / Disability
Figure_1: A conceptual framework of the possible roles and influences that

various factors may play in the development of musculoskeletal disorders
Based on Figure ES1 from National Research Council, 2001 (p.3)
*Where “Individual Factors” refers to Individual Physical and Psychophysical
Factors and Non-Work-Related Activities (National Research Council, 2001).
Discomfort and pain may be precursors of injury, but studies have shown that
whilst MSDs may be incident dependent, e.g. excessive force caused by an
accident, they are more often cumulative in nature. Resulting from repeated or
prolonged low level physical stress on the body, incidents may go unnoticed if
they are insufficient to trigger the body‟s warning system, i.e. pain. If the
task/posture held is repeated with insufficient rest/recovery time, then the
cumulative effect is what is more likely to trigger pain. Consequently, diagnosis
attempts may wrongly focus on the onset of pain; considering recent events,
rather than long term practices, work habits and/or postures adopted by the
individual. To illustrate, computer work involves dynamic and static muscle
loading. Both may result in injury if not well managed, but the contribution of the
static loading element is often overlooked as its impact is less obvious to the
individual. Rapid movement of the fingers during typing places a dynamic load
on the muscles in the hands and fingers that can result in aches and pains
attributable to repetitive actions and/or over-use. Insufficient rest breaks away
from the activity may result in strain and the possibility of cumulative-based
injury. Whilst the fingers are directly deployed in the activity, the muscles of the

arms, shoulders and neck are static, often tense, and may result in discomfort
and/or pain from increased pressure inside the muscle and impediment of blood
(Kroemer and Grandjean, 2003; Louhevaara and Kilbom, 2005).
Symptoms vary with time and between individuals. Turk (1993) reported how
individuals discussing what appears to be the same phenomenon may describe
significant differences in terms of “severity, quality and impact of their pain”.
Consequently, it is important that not only the somatic (sensory) component of
pain is considered, but other factors such as the individual‟s attitudes, coping
efforts, resources, moods/emotion-states, and stress levels. Observation
provides additional data on an individual‟s symptoms or their attitude to pain,
with behaviours such as facial expression (e.g. grimacing) when considering
activities that trigger pain or (un)conscious rubbing, supporting or gesturing to
affected areas (Turk, 1993; Marcus et al, 2007).
1.1.4 Psychosocial and Psychological Factors
Studies have considered the role of psychosocial factors and stress in the
occurrence of MSDs (Westman et al, 2008). Factors influencing performance
and work demands include: personality; self-efficacy; job satisfaction; autonomy;
monotony; boredom; with work stress, fatigue and attention being of particular
interest to the ergonomist (Halsegrave and Corlett, 2005, p816).
The 2007 Psychosocial Working Conditions (Health and Safety Executive,

2007b) survey indicated that around 13.6% of all working individuals thought
their jobs were very or extremely stressful. Stress is a combination of physical
and psychological reactions to events that challenge or threaten the individual.
Under normal circumstances, stress response is a mechanism which allows the
individual to deal with sudden changes, dangers or immediate demands in order
to protect her/his self. Under abnormal circumstances stress can overwhelm and
lead/contribute to ill health (Tennant, 2001; Michie and Williams, 2009). A study
by von Knorring et al (1982) found that individuals with depressive orders who
also reported pain were found to have a significantly higher muscular tension
level than those without pain.
In the workplace, the impact of stress on the individual may include tension,
headaches and MSDs, leading to errors, drops in productivity and possible need
for sick leave. In a systematic review of literature, Michie and Williams (2009)
identified the key work factors associated with work-related psychological ill
heath and sickness absence, which included: long hours worked, work overload
and pressure, lack of control over work and lack of participation in decision
making. In addition, factors external to the workplace such as home and social
life may be common sources of stress; compounding those experienced during
the working day (Tennant, 2001) and contributing to MSDs (Cole and Rivilis,
2004).
Stress may also be task dependant, e.g. computer-related stress. This occurs
when something unforeseen happens, such as a technical fault or software
which blocks a user‟s desired action whilst failing to offer explanation or
guidance as to how to proceed. Depending on the individual‟s technical abilities,

or external factors such as impending deadlines, s/he may become
tense/anxious. If the problem is not dealt with, or if it re-occurs, then frustration
builds. A laboratory study by Dennerlain et al (2003) showed how deliberately
frustrating computer users increases their exposure to physical risk factors, e.g.
frustration may result in increased muscle tension as the user grips the mouse
tighter.
1.2 Management of MSDs
1.2.1 Workplace Legislation
The levels of work-related illness reported by the HSE might suggest a lack of
legislation to protect workers, but this is not the case. Employees within the UK
are protected by a raft of health and safety legislation which covers both the
workplace and work practices. The “Health and Safety (Display Screen
Equipment) Regulations 1992 as amended by the Health and Safety
(Miscellaneous Amendments) Regulations 2002” exists specifically to protect
work-based computer users.
The Display Screen Equipment (DSE) Regulations came into force in January
1993 to implement European directive 90/270/EEC; the aim of which was to
address the minimum health and safety requirements for work with DSE.
Table_1 shows the seven primary DSE Regulations.
1 Citation, commencement, interpretation and application

2 Analysis of workstations
3 Requirements for workstations
4 Daily work routine of users
5 Eyes and eyesight
6 Provision of training
7 Provision of information
Table_1: Primary DSE Regulations (Statutory Instrument 2792, 1992)
The Regulations require the employer to analyse workstations, environment and

work tasks in order to “reduce the risks identified in consequence of an
assessment to the lowest extent reasonably practicable”. The term “workstation”
means an assembly comprising of the elements shown in Table_2:
i. display screen equipment (whether provided with software

determining the interface between the equipment and its
operator or user, a keyboard or any other input device),
ii. any optional accessories to the display screen equipment,
iii. any disk drive, telephone, modem, printer, document holder, work
chair, work desk, work surface or other item peripheral to the
display screen equipment, and
iv. the immediate work environment around the display screen
equipment.
Table_2: Definition of a DSE Workstation
(Health and Safety Executive, 2002)

Coleman and Pearce (1994) point out that “Failure to assess equates to
negligence for all practical purposes”. As the DSE Regulations aim to meet the
needs of all employers with DSE regardless of industry type or size of workforce,
the Regulations act to guide rather than prescribe how specific requirements
should be met. One of the main requirements of the regulations is for employers
to perform a “suitable and sufficient analysis” of users‟ workstations (Health and
Safety Executive, 2002). In itself, that phrase goes a long way to explain why,
despite the existence of Regulations, users continue to experience computer-
related ill health. Words such as “suitable” and “sufficient” are interchangeable,
with meanings changing based on the situation. As a result, the Regulations are
open to interpretation. Misinterpretation, either wilfully or unintentionally, may be
one explanation as to why work-based illnesses such as MSDs are still prevalent
in such numbers. In addition, employers are often unaware of:
 The potential impact symptoms may have on an individual and the
company/organization (e.g. loss of productivity, sick leave, insurance claims)
 The relatively low cost of some preventative measures and adjustments
compared with the potential long term cost to both the individual and
employer if no action is taken. In the UK, sick leave alone cost an estimated
£17.3bn in 2008 (Guardian, 2009)
 Specific legislation or parts thereof. Although, ignorance of the law is no
defence.
The HSE figures (2009) relate to all forms of work, not just computer use.
Despite anecdotal evidence that over 60% of work-based computer users have
experienced symptoms that may be caused/aggravated by computer work
(AbilityNet, 2008), extensive review of literature failed to reveal any current
computer-related statistics. One explanation for this may be that health and
safety surveys gather data on symptoms and accidents/injuries rather than
ongoing conditions. Related data came from research studies on specific user
groups, e.g. Suparna et al (2005) considered the occupational health problems
and role of ergonomics in information technology professionals, or from
industry/media estimates. Bannerjee and Sharan (2003) estimated that 25% of
computer users world-wide had computer-related injuries. The Trade Union
Congress (TUC) (2004) estimated that 1 in 50 of UK workers was experiencing
some degree of RSI. More recently, The Chartered Society of Physiotherapy,
citing HSE figures from 2007/08, called on the UK Government to encourage
employers to do more to prevent and reduce related conditions amongst workers
(The Chartered Society of Physiotherapy, 2009).
1.2.2 The Individual‟s Responsibility
Whilst the main responsibility under the DSE Regulations lies with employers
and their nominated representatives, individual computer users have a legal
responsibility to enforce the regulations in order to protect themselves, their
colleagues and visitors and to ensure that risks are reduced by following safe
working practices. Studies have shown that employees are often unaware of
their employer‟s health and safety and DSE procedures (Mulligan, 2006) and
that, even when they are, users need help in order to maintain long-term
compliance with injury prevention programs (Monsey et al, 2003). Potential
barriers to compliance and adoption of good practice may include:

 Physical factors: an individual‟s lack of ability to detect their own comfort and
symptom levels; loss of proprioception (the ability to perceive the location,
movement and posture of one‟s body in physical space) and how that may
impact/cause symptoms; lack of awareness/perception of potential triggers
and their severity in terms of risk (Mulligan, 2006)
 Psychosocial and psychological factors: self-efficacy; job content/satisfaction;
workload/pace (overload or under-load); role and control (low participation in
decision-making; autonomy); fatigue; work stress; personality; home-work
conflict (Briner and Rick, 2003; Bridger, 2009).
With finance being of ever greater concern to businesses, it is often unrealistic to

provide the traditional in-person assessment method: one assessor working with
one employee in one place at one time (Glasgow, 2004) to observe and review
the individual, workstation and work practices, and provide related training and
information that enables the individual to follow good practices. Self-assessment
is often seen as a cheaper alternative. Placing the onus on the individual, the
employer is able to save costs involved in training internal staff to assess or
employing external contractors.
Self-assessment relies on the individual being aware and involved in the

process, i.e. appreciating why the assessment is important. In a previous study
by this author, lack of self-awareness was found to be a contributing factor in the
failure of self-assessment methods used to identify the presence of risk
(Mulligan, 2006). If the trend towards self-assessment continues, then additional
monitoring methods will be needed to limit the inevitable risks.
1.2.3 Intervention
DSE Regulations 6 and 7 stipulate that users must be provided with training and
information in health and safety aspects of computer work. Studies have shown
that education programs can reduce the severity or occurrence of MSDs
(Olafsdottir, 2004; Greene et al, 2005). If user education were sufficient in the
battle against MSDs then other interventions would not be required; this is not
the case as demonstrated by Montreuil et al (2006).
Intervention by way of workplace ergonomic modification is often vital in the

management of WRMSDs. Example modifications include reducing highly
repetitive and/or forceful movements, correct placement and use of equipment
and lighting, adaptation of furniture and/or equipment to meet individual need,
reducing awkward postures and prolonged periods spent in one position by
ensuring that sufficient breaks are taken, consideration of task and job design
(Bridger, 2009). Modifications cannot be applied in isolation and they may not be
successfully considered or implemented if the need is not identified and
acknowledged (Mulligan, 2006).

1.3 The Study
1.3.1 Background
As a Disability IT Consultant, one aspect of my work involves assessment of

needs and provision of advice, information and support to individuals,
organisations and professionals regarding the prevention of computer-related ill-
health. Often problems exist because risks go unnoticed; individuals, colleagues,
or employers are not aware of the potential outcome of ignoring risk; or belief
that the risk “won‟t happen to me”. Ignored risks can easily have a negative life-
changing impact for the individual. Whilst it is possible to identify preventative
adjustments or adaptations, or to assist where symptoms or disability exists, in
themselves such measures will not result in recovery or cessation of
symptoms/condition. It is necessary to take an holistic approach, involving
ergonomic adjustments, adaptive technology, low-tech solutions, changes to
work flow and/or practices and medical advice and/or therapeutic treatment.
Morse et al (2001) found that in the American State of Connecticut there was
substantial under-reporting of MSD, with estimates of unreported cases
exceeding those officially reported by a factor of 11:1. With individuals unable to
recognise risk, the challenge in the prevention of MSDs is how to achieve early
detection of risk factors before symptoms occur. Haque (2000) proposed the use
of a health surveillance system in order to monitor health and safety in the
workplace, data collection through self-administered questionnaires completed
by employees, managers or supervisors, with feedback resulting from data
analysed by trained staff. With advances in technology, and from a Human
Computer Interaction (HCI) viewpoint, the development of a system which could
monitor the user, detect where and when potential risk exists and then provide
advice as to remedial action to be taken, might now appear to be a more obvious
way of plugging the human awareness gap. This study considers the potential
use of prospective Computer-based Interactive Monitoring Systems (henceforth
referred to as “CIMS”). By developing CIMS around persuasive technology
(captology) and user interaction, the computer and user may work together to
address physical, psychological and psychosocial factors of MSDs with the
ultimate aim of improving user well-being.
1.3.2 Review of Persuasive Technology
Fogg (1998) introduced the term “captology”, which derives from the study of
“Computers As Persuasive Technologies”, to explain where technology and
persuasion overlap. He stressed the need to understand both the effects and
potential of interactive technologies that have the ability to “change beliefs and
behaviours”. Understanding informs design, especially when trying to persuade
users to “change attitudes and behaviours in beneficial ways”. Fogg illustrated
the two domains (computers and behaviour) and their interaction/overlap
(captology) through a Venn diagram. The current version is shown in Figure_2.
As computers become ubiquitous, the scope for persuasive technology

increases. Whilst many studies have considered persuasive technology as a
route to improving health/well-being (Dijkstra, 2006 (comparison of tailored

persuasive messages); de Rosis et al, 2006 (healthy eating); Grollemann et al,
2006 (support for smokers trying to quit)), studies into the use of such
technology within the workplace, and specifically for work-based computer users,
are limited (Morris et al, 2008 (activity based computer breaks)).
Figure_2: Overview of Captology

(Stanford University Persuasive Technology Lab, 2009)
When considering current persuasive technology approaches, a divide appears

to exist between the fields of academic research, where affective computing
considers the individual‟s emotion-state and psychological needs, and
commerce, where ergonomic monitoring systems provide advice based on the
user‟s posture and physical activity. It has not been possible to find any studies
or products which aim to address both sets of needs; the focus of this study.
1.3.2.1 Technology and Emotion Recognition
Affect is the conscious subjective aspect of feeling or emotion. An individual‟s

emotions can influence the emotions, thoughts and behaviours of others and
vice versa (Hareli and Rafaelil, 2008). Affect, emotion, and feeling are all
displayed through facial expressions, hand gestures, posture, voice
characteristics, and other physical manifestation. The ability to detect these cues
through technology could help to prevent/negate negative affect in computer
workers; relieving frustration and anxiety before they have a chance to build,
thus reducing the risk of stress-related health issues occurring.
In order to detect emotional information one must first capture data about the
individual‟s physical state and/or behaviour. This may be achieved via one or
more of the following methods: body posture, gestures, facial expressions,
speech patterns and physiological sensing. In order to recognize emotional
information, meaningful patterns must be identified from the data. At MIT‟s
Affective Computing Lab research into physiological sensing is currently focusing
on: Galvanic Skin Response (GSR), Electrocardiogram (EKG), Electromyogram

(EMG), Blood Volume Pressure (BVP), Respiration, and Temperature (Affective
Computing Group, MIT, 2009). Other studies include:
 Motion Mouse (IBM‟s Blue Eyes Project): evaluates users‟ emotions when
operating a computer. Gathering physical and physiological output, sensors
measure data based on behaviour (mouse movements, button click
frequency, finger pressure) and physiological functions (heart rate, skin
temperature, skin electricity and GSR) (Ark et al, 1999)
 Touchpad pressure to indicate affective state (Mentis and Gay, 2002)
 Chair with pressure sensors used to recognise naturally occurring postures
and associated affective states related to a child‟s interest level while
performing a learning task on a computer (Mota and Picard, 2003)
 RoCo, a robotic computer, designed to move its monitor in subtly expressive
ways that respond to and promote its users‟ own postural movement. Results
showed that users tended to be more persistent in their task when RoCo‟s
posture was congruous to their affective state than when it is incongruous
(Ahn et al, 2007; Breazeal et al, 2007)
Current commercial monitoring systems, such as the Tension Taker by Ultrasis

(Figure_3), blood pressure and heart rate monitors (Vrijkotte et al, 2000), are
intrusive and are generally targeted at the home user, users with medical
problems that need to be constantly monitored or used in laboratory settings.
Commercial products that do not involve monitoring (e.g. relaxation / meditation
CDs, relaxation techniques) also target the home-based user.
Figure_3: Tension Taker
1.3.2.2 Ergonomics and Posture Monitoring
“...those who sit at their work and are therefore called 'chair workers ...
[T]hese workers ... suffer from general ill-health and an excessive
accumulation of unwholesome humors caused by their sedentary life ....”
(sic) (Ramazzini, 1713b)
Ergonomics and posture-based research studies that have made use of

monitoring systems include:
 A computer-aided system to evaluate postural stress in the workplace:
human analysis of a video-based system produces detailed description of
work tasks and a continuous record of trunk and shoulder activity on the
same timescale (Keyserling, 1986)
 A posture monitor designed to support individuals with limited physical
control; by promoting attention to maintaining proper trunk alignment when

seated. Whilst aimed at the disability market, this technology has the scope
to be extended into wider fields (George, 1992)
 A sensing chair that uses pressure distributed sensors to gather information
needed by a “virtual posture coach” to help the computer user maintain
proper sitting postures (Tan et al, 2001)
 Share Aware: an interactive persuasive system to promote awareness of
workstation ergonomics. Customisable system compromising a sensor seat
cover and screen based application, providing information to the user about
posture and duration (Sehgal and Lui, 2004)
 perFrames: Persuasive Picture Frames for Proper Posture: the picture frame
contains a moving portrait of a person known to the user; someone s/he likes
or loves. By providing affective feedback the user is persuaded into adopting
better sitting habits while working at a computer (Obermair et al, 2008)
 SuperBreak: Using interactivity to enhance ergonomic typing break. A
customisable system that provides activities for the user to conduct during
rest breaks from computer use, e.g. activity and vision-based game and
vision-based document reading (which allows the user to defer document
reading until break session and requires hand gestures to turn pages, change
document) (Morris et al, 2008).
From the studies listed above it can be seen that research is beginning to
change from posture detection to include interactive, persuasive systems that
focus on the user‟s posture, comfort and well-being.
Commercial technology aimed at work-based computer users focuses on

encouraging the user to take breaks from her/his computer; some software
utilities include suggestions for stretching exercises. Support for these utilities
comes from studies that have considered a range of factors including: the
influence of breaks on fatigue (Laporte, 1966), muscle endurance/strain
(Hagberg, 1981) and static load (Jonsson, 1988); effect of different work-rest
schedules (Koparadekar and Mital, 1994; Balci and Aghazadeh, 2003),
performance, e.g. productivity and/or error rates (Henning et al, 1989); influence
of exercise/stretching (Laporte, 1966; Hagberg, 1981; Galinsky et al, 2007); and
the individual‟s ability to self-manage breaks (Henning et al, 1996).
Monitoring methods utilised by break reminder utilities currently include:

 Activity: keyboard and pointing device use is monitored, e.g. the system
counts keystrokes, button clicks, movement of the mouse, and advises the
user to take a break once thresholds have been reached
 Time: the system advises the user to take breaks based on the passing of
time, e.g. a prompt may be issued every 30 minutes
 Time and activity: the system‟s advice is based on time passing, taking into
account activity. It will not prompt the user to take a break if a natural break in
activity has occurred
 Posture: by utilising a webcam the system monitors the user‟s posture and
then provides prompts as to remedial action
Table_3 shows a selection of break reminder utilities and the monitoring

method(s) utilised:

Monitoring Method
Product Name Activity Time Posture Product Status
KAZGuard Yes No No Bundled
Mousetron Yes No No Free
PostureMinder No Yes Yes Commercial
RSIGuard Yes Yes No Commercial
SoundBreak No Yes No Free
StretchBreak No Yes No Commercial
WorkPace Yes Yes No Commercial
WorkRave Yes Yes No Free
Table_3: Example Break Reminder Software Utilities
1.3.3 Computer-based Interactive Monitoring Systems (CIMS)
As MSDs are multi-factorial in nature an holistic approach is called for. This

study considers the potential use of prospective Computer-based Interactive
Monitoring Systems (CIMS). Based on persuasive technology, multi-factorial
CIMS (which focus on both the user‟s emotional and physical states) work with
the user to address physical, psychological and psychosocial factors of MSDs.
The ultimate aim of CIMS is to improve user well-being. This would be achieved
through the proposed CIMS:
 monitoring the work-based computer user across the working day
 detecting the individual‟s ergonomic state (e.g. posture, use and position of
equipment and furniture, work tasks, work habits, local environment) as well
as her/his psychological state (e.g. attention, fatigue, frustration and stress
levels, emotions)
and
 providing advice on what remedial action may be taken.
Through a qualitative approach this study will consider work-based computer

users‟ attitudes towards the proposed multi-factorial CIMS approach. The aim of
the study is to explore potential for, and limitations of CIMS through the eyes of
the end user; employers‟ views are not considered here:
 Why might users welcome, tolerate or reject CIMS?
 Do symptoms influence attitude?
 What perceived barriers (personally, professionally and/or technically) might
prevent users from taking advantage of such systems?
 What risks would users want CIMS to detect?
 What monitoring and detection methods would end users accept / prefer?
These and other questions will be considered by way of two data collection
stages:
 Stage 1: a survey that considers the factors that might influence an
individual‟s potential acceptance (welcome, tolerate or rejection) of CIMS

 Stage 2: one-to-one, semi-structured interviews that consider the issues
identified within the survey feedback and explore points of interest raised by
the participants.
Thematic analysis of the data will establish potential users‟ concerns of and
requirements from CIMS (Chapter 3) and this will be followed by discussion of
the results and major findings (Chapter 4).

2. Methodology
A qualitative study was conducted to consider factors that might influence a

work-based computer user‟s attitude towards computer-based interactive
monitoring systems (CIMS). Qualitative research is a naturalistic interpretative
approach, concerned with understanding the meanings people attach to actions,
beliefs, decisions, and values. This may be achieved through learning about the
participants “social and material circumstances, their experiences, perspectives
and histories” (Ritchie and Lewis, 2003).
The study comprised two primary data collection stages: Stage 1 (survey) and
Stage 2 (interview). The survey‟s purpose was to identify factors influencing an
individual‟s potential acceptance (welcome, tolerate or rejection) of CIMS. One-
to-one, semi-structured interviews at Stage 2 considered the issues identified by
survey feedback and explored points of interest raised by the participants. At the
analysis stage feedback was sought from the interview participants in order to
confirm that their views had been accurately reflected and to request any post-
interview thoughts. The three collection methods enabled data triangulation.
2.1 Stage 1 (Survey)
A combination of purposive and convenience sampling was conducted.

Purposive sampling occurs when respondents are chosen because they have
particular features or characteristics which will enable detailed exploration of the
research objectives (Office for National Statistics, 2009a). By contrast,
convenience sampling occurs where little or no attempt is made to ensure that
the sample is an accurate reflection of the population, i.e. the researcher uses
whoever is available (Office for National Statistics, 2009b).
For the purposive sampling method personalized invitations were sent out to 95
individuals, all of whom were known to the researcher in some capacity, e.g.
client, colleague, acquaintance, friend, family member. The invitations explained
the purpose of the study and contained a copy of the survey, which in turn
contained a copy of the study Information Sheet (see Appendix_1, 2 and 3). 93
invitations were emailed and 2 were posted.
Personalized requests were also made of employer representatives and group

leaders for onward distribution of the survey invitation to their colleagues/group
members. Although the final number is unknown, it is estimated that these
requests had the potential to extend the survey‟s scope by a further 100+. Whilst
the researcher had no control over who did/did not receive the survey
(convenience sampling), the representatives were selected based on their ability
to reach populations who were underrepresented in the purposive sample, i.e.
males and those individuals without reported symptoms.
An Informed Consent Form was not used for the survey stage of the study, as
return of the completed questionnaire was taken as consent to participate.

The 40-question survey was designed to elicit feedback from the participants on
experience of work-related MSDs, DSE procedures, and attitudes towards
potential CIMS. The survey was piloted with two volunteers: a female office
manager with symptoms (thumb and shoulder) and a male IT Support
Technician with no experience of symptoms. Feedback received informed
modifications.
The questionnaire contained three sections:

Section 1: General, e.g. job title, industry type, length of time spent at the
computer, style of computer, keyboard, DSE experience
Section 2: Symptoms, e.g. existing or historic symptoms, location, severity,
changes made to address symptoms. Participants with no
symptom history were asked to skip this section
Section 3: Design for User Need, i.e. consideration of example interactive
affect and ergonomic monitoring methods. Participants were asked
whether they would welcome, tolerate or reject various methods
and provide supporting comments for their responses
Table_4 lists the CIMS categories which formed the basis of the investigation;
selected in order to cover both physical and emotion-state detection methods.
The categories were presented as examples, which might be used on their own
or combined to form multi-factorial CIMS. Participant suggestions for other
detection methods (Survey Question 39 (Appendix_6c)) informed Stage 2.
CIMS Category Example detection methods

A Keyboard use  key action (force/pressure used)
 position of keyboard on work surface
B Pointing device use  hand/finger pressure on device
 grip position
 button action (force/pressure used)
 speed and range of movement
 position of device on work surface
C Head position in relation to  distance from screen
the screen
D Seated position  fully in chair with back supported
 perched
 fidgeting
E Upper body posture  leaning towards the screen
 leaning to one side
F Facial expression  frowning
 eyebrow positions
G Eye size  changes can indicate mood
H Eye gaze  rapid movement
 lack of movement
 tracking eye gaze across screen
I Voice monitoring  volume of speech
 tone
 words used
Table_4: Example Computer-based Interactive Monitoring Systems (CIMS)

Participants were permitted to skip questions they did not wish to answer or
withdraw from the survey at any time. An explanation of the interview stage of
the study was provided and participants were asked to declare whether they
would be willing to take part by selecting “yes”, “no” or “undecided”.
Of the 95 individuals polled 34 intentions to participate were received, resulting

in 28 completed surveys. An additional 10 surveys were received as a result of
the employer/group requests, resulting in a total of 38.
2.2 Stage 2 (Interviews)
26 out of the 38 survey participants volunteered to be interviewed. An additional

five (5) stated that they were “undecided”, providing a potential interview pool of
31. Within the available timeframe, 13 interviews were conducted: 11 in person,
one (1) by telephone and one (1) by email. Interviewees were selected based on
convenience sampling (availability and location). Copies of the study Information
Sheet, Informed Consent Form and example interview questions were sent to
the interviewees (Appendix_2, 3 and 4); this allowed queries to be addressed
ahead of the session.
Interviews were held at the interviewee‟s preferred location; nine (9) choose their
employer‟s premises, two (2) their own home (also serving as a working
location), one (1) by telephone and one (1) by email. Before each interview, the
purpose of the study was re-explained and outstanding questions addressed.
Interviewees were asked to read and sign the Informed Consent Form. An option
to amend the form was provided, e.g. crossing through or re-wording any part.
Informed consent was acquired via email correspondence for the remote
interviews.
In-person interviews were recorded by audio digital recorder; key points and
observation notes recorded in writing. Technical issues with sound quality
rendered audio recording unworkable for the telephone interview; the interview
was recorded in writing.
The interviews were conducted on a semi-structured basis. Example questions

acted as a guide. Additional topics and interviewee thoughts were explored as
they occurred. The example questions developed from professional knowledge
of existing intervention practices and solutions, and from literature and
commercial product reviews (Section 1.3.2). In addition, recurring
themes/patterns identified from survey feedback, together with participant
suggestions, comments and unexpected responses, informed the interview and
its structure. Questions were designed so that participants with and without
experience of MSD symptoms could constructively contribute to the study. They
were developed and sequenced with the view to taking the participant on a
journey from any existing/historic symptoms and coping strategies, through to
issues which might surround their acceptance of CIMS.
The questions and interview process were piloted with the two study volunteers.
This proved invaluable as it highlighted where questions provided insufficient

explanation of the topic being considered. An example of this was with Interview
Question J1, “Trust (in the system)”, where the addition of a definition of trust
and an example of where trust might be an issue aided interviewee
comprehension. Piloting also identified where participants might struggle to
articulate their thoughts, e.g. when requesting pilot volunteers to describe how
certain events made them feel. This resulted in the development of a word grid
for Interview Questions A1, C and G (Figure_4). The grid contents were based
on basic emotions identified by emotion theorists such as Arnold, Izard and
Plutchik (referenced in Ortony and Turner, 1990), with additional words being
identified through discussion with the volunteers.
FIG_4: Word Grid used for Interview Questions A1, C and G

A1 = “If you experience symptoms whilst working (or as a result of
working), e.g. stress, headaches, eyestrain, physical discomfort,
how/what does that make you feel?”
C= “If you decide to take a work or rest break away from your
computer, how/what does that make you feel?”
G= “If the system advised you to take a work or rest break away
from your computer, how/what would that make you feel?”
As CIMS is prospective user testing was not possible. To aid participants‟

understanding of CIMS, explanation of existing persuasive technology products,
academic studies and experimental solutions was provided where appropriate.
At the end of the interview session, thirteen images of work and computer-based
situations were shown to the interviewee singularly (Appendix_5). The purpose
of this was to elicit instinctive reactions to each image/situation depicted and to
establish whether or not the interviewee perceived there to be any risk, in terms
of physical and/or emotion-state.
2.2.1 Thematic Analysis
Qualitative analysis identifies emerging categories, themes and theories from the
data, rather than trying to establish whether data meet with prior knowledge or
ideas (Greenhalgh and Taylor, 1997). Guidelines are applied flexibly to meet the

needs of the study, research question(s) and/or data. Adjusting methods as the
study develops in light of information collected allows the researcher to be
“sensitive to the richness and variability of the subject matter” (Greenhalgh and
Taylor, 1997). For this study, Thematic Analysis was selected based on its
ability to develop a story of the research study from the themes identified in the
interview transcripts. Table_5 shows the phases of this approach as described
by Braun and Clarke (2006).
Level 1: Familiarizing yourself with your data: transcribing data (if

necessary), reading and re-reading the data, noting down
initial ideas.
Level 2: Generating initial codes: coding interesting features of the
data in a systematic fashion across the entire data set,
collating data relevant to each code.
Level 3: Searching for themes: collating codes into potential themes,
gathering all data relevant to each potential theme.
Level 4: Reviewing themes: checking if the themes work in relation to
the coded extracts (Level 1) and the entire data set (Level 2),
generating a thematic „map‟ of the analysis
Level 5: Defining and naming: themes: ongoing analysis to refine the
specifics of each theme, and the overall story the analysis
tells, generating clear definitions and names for each theme.
Level 6: Producing the report: The final opportunity for analysis.
Selection of vivid, compelling extract examples, final analysis
of selected extracts, relating back of the analysis to the
research question and literature, producing a scholarly report
of the analysis.
Table_5: Phases of Thematic Analysis (Braun and Clarke, 2006)
2.3 Conventions
Table_6 lists the abbreviation conventions used throughout the rest of this paper:
Abbreviation Description
Pn(g) Participant number (followed by gender)
e.g. P21(F) relates to Participant Number 21 (who is
female)
SQn Survey Question number
e.g. SQ12 relates to the survey question which asks
“Where is your primary workstation/desk location?
IQ-an Interview Question number
e.g. IQ-B3 relates to the interview question which asks
“How do you measure the success of a strategy?”
Table_6: Abbreviation Conventions Used in Paper

3. Analysis and Results
Whilst a qualitative approach has been taken in this study, it was necessary and
beneficial to conduct qualitative and quantitative analysis on the data. In Stage 1
(Survey) participants were encouraged to provide comments to qualify
responses and provide additional feedback. Few took advantage. As a result, the
scope for qualitative analysis was limited and a predominantly quantitative
approach was taken, with totals and/or percentages illustrating how participants
responded (Section 3.1). By comparison, Stage 2 (Interview), where transcripts
of the interviews provided the bulk of the data, a predominantly qualitative
approach was possible (Section 3.2).
3.1 Stage 1 (Survey)
38 surveys received.
3.1.1 Section 1: General
Demographic characteristics relating to gender, age, and industry sector are

presented in Table_7. Females and participants working for charity/not-for-profit
organisations dominate the survey population. 76% of participants work full-time
and 60% have been in their current job over two years (34% “two years or more”,
26% “more than 5 years”).
Demographic Characteristic Description n %

Gender Female 28 74
Male 10 26
Age 21-30 11 29
21-40 11 29
41-50 4 11
51-60 12 32
Industry Sector Public 7 18

Private 7 18
Charity / Not-For-Profit 23 61
No reply given 1 3
38 100
Table_7: Demographic Characteristics: gender, age, industry
Every participant spent at least 3 hours at their work computer each day (55%
“between three and six hours” and 45% “between six and eight hours”). When
asked whether or not their employer provided DSE assessments:
 82% replied “yes”
 3% “no”
 8% “don‟t know”
 8% did not answer.

Some participants qualified their responses and five (5) reported never receiving
an assessment, despite being with their current employer for at least one year
(Appendix_6a).
34 participants (89%) reported historic or current symptoms which they attributed

to, or believed were worsened by, work. Of those, 27 (79%) work for employers
who purport to comply with DSE Regulations. As can be seen from Table_9, the
provision of DSE assessments does not ensure good practice. When
considering the longest time they might spend at their computer before taking a
work or rest break, 82% of the survey participants (69% of DSE compliance
participants) reported spending over the recommended one hour (DSE
Regulations, 2002).
No DSE DSE
Time spent Compliance Compliance Total
n % n % Total %
Less than 1 hour 2 29 5 13 7 18
Between 1 and 2 hours 1 14 16 42 17 45
Between 2 and 3 hours 3 43 9 24 12 32
3 hours or more 1 14 1 3 2 5
7 100 31 100 38 100
Table_8: Analysis of feedback from Survey Question 14:
“What might be the longest length of time you spend working at your
computer before taking a break, i.e. short break away from the computer
for telephone calls, paperwork, filing, photocopying, comfort break?”
3.1.2 Section 2: Symptoms
Chart Notes:
 The Y-axis labels for the charts shown here have been truncated to
save space and allow the data to dominate.
 Full data labels may be found in the survey (Appendix_2).
Participants reporting pain were asked to complete Section_2 of the survey. As

can be seen from Figure_5, (SQ27: “Which of the following statements
describe(s) your symptoms….”), participants regard their symptoms as being
predominantly transitory in nature, with 54% of responses accounted for by:
 “occasional” (14)
 “episodic” (12)
 “generally wearing off overnight or across the weekend” (10).

Figure_5: Response distribution for Survey Question 27:
“Which of the following statements describe(s) your symptoms”
When asked to map their symptoms to body areas, (SQ28: “Please indicate
which area(s) bother you”), as anticipated from literature reviews and
professional knowledge of computer-related MSDs, participants identified
symptoms within the upper body and lower arm as being of most concern (88%)
(Figure_6). Despite anecdotal evidence that most of the participants experience
degrees of stress, tension or fatigue, only 5% declared these as health concerns.
Figure_6: Response distribution for Survey Question 28:

“Which area(s) bother you”

In SQ29 participants were asked to declare the single body/symptom area
concerning her/him most. As some participants felt unable to select just one
area, the total number of responses (40) is higher than the anticipated 34. All
responses bar one (hips) were contained within the upper body, with “Lower
back” (25%) and “Shoulder” (20%) identified as the top two areas. Table_9
shows the ranked positions for reported symptom locations.
Rank Location n %
1 Lower back 10 25
2 Shoulder 8 20
3 Neck 5 12.5
4 Head 4 10
4 Eyes 4 10
6 Hand 3 7.5
7 Upper back 2 5
7 Hips 2 5
9 Shoulder blade 1 2.5
9 Wrist 1 2.5
11 Other locations were not selected 0 0
40 100
Table_9: Ranked positions for Survey Question 29:
“Please indicate which area(s) bothers you MOST”
In terms of discussing their symptoms with others, the top three selections were:
 DSE assessor: 16 (24%)
 Family: 14 (21%)
 GP/doctor: 9 (13%).
Four (4) participants admitted not discussing symptoms with anyone. Reasons
are shown in Appendix_6b.
3.1.3 Section 3: Designing For User Need
All participants were asked to complete Section_3 of the survey.
Figure_7 shows how the participants responded to SQ35, SQ36, and SQ37
which asked if they would “welcome”, “tolerate” or “reject” example CIMS;
participants were asked to “select all that apply” for each category of
acceptance. As the chart shows, CIMS relating to equipment use, position and
posture achieved higher levels of acceptance than those focusing on emotion
recognition; this finding was supported by Stage 2 (Interview).

Figure_7: Response distribution for Survey Questions 35, 36 and 37:
“Would you welcome (35), tolerate (36) or reject (37) any of the following
detection methods”
Table_10 shows the CIMS ranking provided from SQ38, where participants were
asked: “From those methods which you would either WELCOME or TOLERATE,
which detection method would you find MOST acceptable?”. These results
confirm the participants‟ higher acceptance of physical over emotion recognition
systems.
One explanation for the weighting towards physical methods might be perceived
familiarity. 79% of survey participants reported never using an ergonomic, work
or symptom-based break utility (commercially available persuasive technology).
As the physical CIMS methods use familiar entities, e.g. the keyboard, pointing
device, and user‟s posture, it may have been easier for participant‟s to imagine
how they might be used to monitor and detect risk(s). Participants had no frame
of reference for the facial expression, eye and voice-related methods.

Rank Location Responses
1 Seated position 15
2 Upper body posture 12
3 Pointing device use 6
4 Keyboard use 3
5 Head position 2
6 Facial expression 1
6 Eye gaze 1
8 Eye size 0
9 Voice monitoring 0
TABLE_10: Ranked positions for the survey Question 38: “From those
methods which you would either WELCOME or TOLERATE, which
detection method would you find MOST acceptable?”
NOTE: P24(M), P25(F) and P37(F) each selected two CIMS instead of
the request one, and P26(F) declined to answer
3.1.4 Final Comments
At the end of the survey participants were invited to make final comments / study
observations (Appendix_6d). The majority supported the survey data trends, i.e.
employers are not as proactive as they should/could be and individuals feel that
they should be able to manage their own well-being. The level of symptoms
reported support the first trend, but indicate that despite their beliefs individuals
are unable to self-manage.
3.2 Stage 2 (Interview)
3.2.1 Word Lists
For IQ-A1, C and G participants were presented with the word grid shown in
Figure_4 and asked to select all of the words applying to the question presented.
For IQ-A1, “If you experience symptoms whilst working (or as a result of
working), e.g. stress, headaches, eyestrain, physical discomfort, how/what does
that make you feel?”, negativity was the dominant feeling (70% of responses).
The word cloud shown in Figure_8 depicts the dominance of each word; where
word size is based on the number of times that word was selected from the grid
(the colour/shade of the words in the cloud has no relevance). The words
“impatient” and “irritated” dominate (11 and 9 responses respectively).

Figure_8: Word cloud depicting dominance of responses to IQ-A1:
“If you experience symptoms whilst working (or as a result of working),
e.g. stress, headaches, eyestrain, physical discomfort, how/what does
that make you feel?”
Word Occurrence
Impatient 11
Irritated 9
Inefficient and Frustrated 5
Annoyed, Compromised, Anxious, Ineffectual, 4
Preoccupied, Depressed
Uneasy, Pensive, Disappointed, Fear, Satisfaction, 3
Dispirited, Worried, Defiant, Weak, Bored, Indifferent,
Thoughtful
Remaining words 2
For IQ-C, “If you decide to take a work or rest break away from your computer,
how/what does that make you feel?”, the overall feeling was one of positivity
(57%). The top two responses were positive in nature, being “relieved” and
“relaxed” (5 responses each), with “uneasy”, “irritated” and “comforted” sharing
third place (3 responses each).
For IQ-G, “If the system advised you to take a work or rest break away from your
computer, how/what would that make you feel?”, despite the top two responses
being negative, “annoyed” and “irritated” (5 responses each), positive words
occupied 10 out of the next 11 positions, resulting on an overall positive
response (60%).
Whilst participants viewed break from the computer as positive in nature, as

Table_9 shows, individuals appear unable to self-manage these breaks.

3.2.2 Themes
Following each interview recordings and notes were transcribed and initial
analysis conducted. Reading of transcripts informed subsequent interviews and
provided direction for literature reviews (Table_5: Level 1). The transcripts were
analyzed on a line-by-line, sentence or paragraph basis according to relevance
of content, i.e. at what level meaning could be attributed. Codes were assigned
to data segments (Level 2). Whilst themes began to emerge (Level 3), it was not
until all transcripts had been coded that meaningful review could take place in
order to confirm over-arching themes, sub-themes and which were not supported
by other transcripts (Level 4).
Coding allowed for themes and sub-themes to be analysed for frequency and
relevance (Table_11). Refinement of the themes identified where overlapping
occurred and allowed for clearer definitions and naming (Table_5: Level 5), e.g.
it was possible to blend “Change” in to “Coping Strategies” to form a single
theme which reflected “actions which the individual instigates for her/himself in
order to prevent or mitigate symptoms”. Further analysis identified that the theme
could be dropped from the study as most were likely to continue whether or not
the user had access to CIMS.
Trust was identified as an over-arching theme, with themes of “Purpose” (of

CIMS), “Choice and Control”, and “Privacy” being linked to the individual‟s ability
to trust CIMS and her/his employer‟s deployment of CIMS. Self-awareness (or
lack thereof) and self-confidence were also linked to trust, but in a less obvious
way. Analysis of the interviewees‟ comments identified the fact that the majority
did not trust their ability to contribute to their well being, with behaviour swayed
by work demands, peer pressure and lack of self-awareness, e.g. loss of
proprioception or track of time.

CHANGE PRIVACY
= factors individuals change to relieve = concerns and issues raised
symptoms / how they view approach:  Identification (e.g. too personal if
 Location can be identified through system)
 Posture = move, stretch, walk  Misuse
 Reactive (rather than proactive /  Not bothered (by issues of privacy)
pre-emptive)  Others made aware of problems
 Task  Posture versus affect
 Security (trust, data protection)
CHOICE / CONTROL PURPOSE
= users want choice and control = the how, what, when and why
 Control over who has access, when  Ability to review / track trends
and why  Justification for change,
 Override, i.e. ability to override expenditure etc.
system if they disagree with advice  Posture vs. affect vs. general DSE
or timing of advice, i.e. ignore (e.g. environmental elements)
prompt to take a break  Propose remedial action / solutions
 System settings, e.g. ability to turn  Provide context
system ON/OFF, adjust feedback  Relevance
timing/format, log format, save  Reminder of good practice
frequency and so on  Support individual
 What the system monitors, i.e.  Warning (identification of bad
affect, posture, DSE, or habits, undesirable postures)
combination
COPING STRATEGIES SELF
= existing strategies used = caused by / resulting in
 DSE-related, e.g. changes to  Time, e.g. locked-in, too involved
furniture, equipment,  Proprioception (lack of)
posture/position, settings, work Behaviour, e.g. static for too long
habits and so on  Attitude, e.g. pull of work
 Exercise, e.g. from gentle stretching
 Beliefs, e.g. peer pressure
to sporting activities  Self-confidence
 Letting off steam TRUST
 Medication, i.e. prescriptions and/or
= concerns and issues raised
over-the-counter  Accuracy (ability of system to
 Movement correctly detect and advise on
 Reactive (rather than proactive / situation)
pre-emptive)  Agreement (contract with computer)
 Relaxation techniques, e.g.  Consultation (establishes trust)
massage, meditation, sauna  Relevance (reason for each
 Therapeutic treatment, e.g. element of system)
physiotherapy, sports therapy  Reliable (posture versus affect)
 Sceptical (how can system know
me better than I do)
 Security / Employer misuse (could
be used against individual if privacy
and data protection not adhered to)
TABLE_11: Themes and Sub-themes Identified From Interview Transcripts

3.2.3 Trust
Taking “trust” as a theme in its own right, the main issues raised by participants
were: trust in technology; trust in CIMS (emotion recognition versus posture
recognition); and trust in their employers.
3.2.3.1 Trust in Technology
Before considering their potential for trust in CIMS per se, several clarified their
view of technology in general:
P1(F): “Well, like all computer systems, I am very sceptical of their working
100 per cent of the time”
P10(F): “... you know, every computer system that kind of thing crashes or has
little gremlins that might make the data that is related to me slightly
flawed and then might make me adjust in a way which not necessarily
relevant” (sic)
P14(F): “... I think I would only want to use something that was automated or
computer driven, if before that I had had a person actually go through
with me the kind of messages it should be telling me and then if I did
have a problem, like the video was telling me to lean to the left, then it
would have been explained to me that occasionally it would tell me to
lean to the right, but to ignore it and all of that kind of thing. So, yeah, I
wouldn't want to just solely trust the system”
P18(F): “... I see it as a supportive system. I would definitely not rely on it. I
wouldn't sit and wait for it that it hasn't reminded me to whatever ... it is
to help me do a better job. I can't base my performance on it. I
wouldn't be too fussed if it forgot to ping when it wasn't working today.
That would be fine. I wouldn't put that much reliance on it”.
3.2.3.2 Trust in the System (emotion recognition versus posture recognition)
When asked to rank the example CIMS in terms of trust, where “1” represents
the system they would trust most and “9” represents the system they would trust
least, there was a clear divide between those systems participants perceived as
being able to measure something in time and space, e.g. mechanical use of
equipment (e.g. force, frequency, time), location/position of equipment and/or
user, compared with systems participants felt were more open to interpretation,
e.g. facial expression, voice monitoring (Table_12).

Example Monitoring Method Ranked Position
in terms of Trust
A Keyboard use 1
(e.g. key action (force/pressure used), position
of keyboard on work surface, number of
presses)
C Head position in relation to monitor 2

(e.g. distance from screen)
E Upper body posture 3

(e.g. leaning towards the screen, leaning to one
side)
B Pointing device use 4

(e.g. hand/finger pressure on device, grip
position, button action (force/pressure used,
number of presses), speed and range of
movement, position of device on work surface)
D Seated position 5
(e.g. fully in chair with back supported,
perched, fidgeting)
F Facial expression 6
(e.g. frowning, eyebrow positions)
H Eye gaze 6
(e.g. rapid movement, lack of movement,
tracking eye gaze across screen)
G Eye size 8
(e.g. changes can indicate mood)
I Voice monitoring 8
(e.g. detecting the volume of your speech,
tone, words used etc)
Table_12: Trust Ranking Positions for Example Monitoring Systems

from questions IQ-J2
= Please rank the identified monitoring methods in terms of trust, where
“1” is the method you would trust most and “9” is the method you would
trust least.
Explanations for this clear separation of trust in physical versus emotion

recognition included:

P15(F): “I was thinking more that I would have more trust in it about posture ...
because it is actually measuring something, so its ... presumably with
posture it would know where I am in position within an area, so it is
actually what springs to mind is a measurable thing. ... I suppose
things like facial expression are measurable things, but not in my mind
not in the same way as posture. Because obviously it is seeing that
you are frowning for example but it's not an actual measurement like it
can't .... whereas with body posture it can say "you are this many
centimetres off centre", which is very factual, but with the frown you
could be frowning just a little bit and it could be not in response to your
actual work - could be a loud noise outside or something. Also, if I get
some good news then I might stay happy for the rest of the day even
though the work that I am doing is frustrating or potentially making me
tired”.
P18(F): “Keyboard use would definitely be number one and pointing device
number 2. Much more likely to trust something that I can see ...
understand how it measures, so posture ones I would trust more”
P31(F): “I think to use the words in the survey, I would "tolerate" the computer
commenting on a few things like your body posture or your distance
from the screen, ... even when I think of it watching my eye
movement..... ok... but, when it comes to the system analysing other
things through facial expression then I don't think ... those things just
feel, personally I don't think the technology could accurately tell me
more than I would know myself. ..... I think my earlier comments were
based around the belief that the technology is not sophisticated
enough to make those judgements about your moods, so therefore it's
invalidated in my head”
3.2.3.3 Trust In the Employer
Trust in employers elicited very mixed responses from participants, ranging from
complete faith to complete mistrust.
When asked how she would feel if the system saved the data so that her
employer could review it, participant 5 responded:
P5(F): “Yeah, that's an interesting one. (pause). Uh, yes, if they were using it
to improve your working situation. I don't, know, uhm, that's tricky. I
say, yes. You have to trust your employers”
Participant 14 acknowledged her employer‟s right to access the data, providing

she was consulted first:
P14(F): “ ... and I suppose because they (employer) would be paying for it, the
software, so then it seems reasonable that they would want to monitor
how it was affecting you, and whether you are improving ... but, I
would want to be consulted if it was going to be accessed”
Participant 15 voiced concerns about the “remote” aspect of employers

monitoring staff:

P15(F): “My initial reaction is that I would like the control. ... I don't like the
thought of being monitored I suppose. Also, it's monitoring where you
can't necessarily see that you are being monitored. I don't know, if you
are sat next to your boss that's fine, but if I'm being monitored by a
camera ... I don't know, there is something about that which is
disconcerting. So, I guess I am slightly cautious rather then strongly
"no"”
Several participants wanted assurances as to how the data would be used.

Participants 18 and 23 sum up the feeling:
P18(F): “I would want assurance that it was not going to be used against me,
not personally, but as an employee. I think it should come with an
assurance that those who agree to it ... that it isn't used against them”.
P23(M): “I'd want to know exactly the fact that they are doing it or wanting to
get access to it. I'd want to be in a position to give permission or not.
We all know how well people can present reasons for doing
something, but it comes back to trust”
Whereas, others refuted the employers‟ right to access:
P21(F): “... so if they are doing it remotely and monitoring use of their
equipment that's one thing, but then monitoring me as a piece of
equipment that's quite different”
P31(F): “I wouldn't like it at all. Not at all, no (employer having access to data).
In the worst case, it could be used as evidence against you”
3.2.4 Purpose
The perceived purpose of CIMS is to support the individual in achieving well-

being, managing symptoms. Participants were adamant that the data gathered
should not be used against individuals in any employment disputes.
P15(F): “....I mean obviously it would have benefits because if there were any
changes that need to be made, you could sort of say this and this has
been logged please could I have a different keyboard to help me that
kind of thing .... so, supportive rather than ammunition against me”
In terms of how CIMS would meet its goal supporting the individual, the following
suggestions were made:
P5(F): “I think that I would want them (CIMS) to monitor anything that could
be damaging long term, so that if I continue doing it, like, a couple of
months or whatever, .... yeah, I wouldn't want it to pick up on little
things that didn't really matter because that would be annoying”
P14(F): “ ... if I felt that I was anxious and couldn't really understand why then
maybe something that would monitor your stress or emotions would be

quite useful but, if I wasn't having any problem then I would maybe
feel that it was a bit too much to have that”
P16(M): “I'd expect it to check on my position at the workstation, monitoring the

way I am sitting. Also the way I am holding the mouse, if I am placing
pressure on my wrists, and sort of pressure I put on the keyboard.
Whether I am over exerting my fingers. I'd expect it to measure heat,
temperature in the workplace, cos this office can get quite warm and I
know that temperature can affect work performance”
3.2.5 Choice and Control (Autonomy)
From iterative analysis of the transcripts it was possible to rename “Choice and
Control” to “Autonomy”, i.e. personal independence, an individual‟s right to
choice and control.
Participants wanted the choice as to whether to use CIMS, or elements of CIMS,

rather than being forced to. At best lack of autonomy would frustrate them:
P1(F): “I would not want to be prevented from getting on with the task in
hand. Cos that affects my autonomy and anything that affects my
autonomy goes against the grain with me in any context (laughs) I
know myself well enough these days (laughs). So, to be told that I
can't use my computer because the computer says so would have me
throwing it through the window”
At worst, enforced usage might lead to individuals seeking alternative

employment:
P21(F): “I suppose the question is ... at what point would I decide it is too much
and leave”
Combining purpose and autonomy together, Participant 23 had strong opinions:
P23(M): “What I want it to do is to warn of impending danger of injury and not

just that, but to provide information about best practice and any
corrective action or strategies to follow in order to minimise the risk of
injury occurring. Where symptoms exist, it should try to either relieve
the symptoms by offering suggestions about taking a break or carrying
out some stretches/exercises (to be used advisedly). What I wouldn't
want it to do is to take control away from me”.
When considering the practicalities of using CIMS, participants had a wide range
of preferences and suggestions. Each voiced her/his preferences and dislikes,
but there were few commonalities. By providing the user with control over CIMS
settings and incorporating multiple modalities, such as text, graphics,
animations, video and audio, CIMS may be customised to meet individual
changing needs, e.g. several interviewees raised the issue of not wishing to
have audio as that would not only alert her/him to the system‟s prompt, but also

their colleagues would be aware that a problem may have been detected (loss of
privacy). In contrast, other interviewees felt that audio would be particularly
beneficial to clarify matters, allow one to listen to the prompt rather than
necessarily looking up at the screen to read it, and to provide companionship for
solo or home-based workers (CIMS as social actor).
3.2.6 Privacy
In answer to the specific privacy questions (IQ-I1, and I2), most participants
could not readily recognise an issue. Once the conversation delved deeper into
the issues surrounding methods of data capture, data storage/format, and so on,
the comments made by participants indicated where trust issues might come into
play:
P15(F): “... I don't know that I would just want it to be free information because,
again, people would interpret it in a different way, mmm ... yeah..... I
suppose I would have a reservation, because once it's logged, IT IS
logged, if that makes sense”.
P17(F): “I'd want it on my hard drive, others would be wary, sensitive, all sorts
of issues … want it to be secure. I'd want to be the only person who
could get at it, so yes, passworded, encrypted etc.”
P31(F): “I like the idea of it only being accessible by me and not by system
operators.... The control for that data that is saved needs to be in my
hands completely”
Another privacy factor was with those detection and reporting methods which
had the potential to identify individuals, and so encroach on their privacy. For
some it was a matter of voicing concern which might need further consideration:
P10(F): “Not major issues, but I am not overly keen on the last three, eyesight,
eyegaze and voice monitoring. The others I have no issue with at all,
but they (last three) just seem a bit more personal and, you know, I am
very identifiable by my eyes and my voice whereas my posture if, you
know, you can't see my face too much, then ...... (shrugs)”
P16(M): “I think I don't like sounds like beeps and that, cos I think that would be
invasive for colleagues so, sort of a system of messages popping up
on the screen. I'd know it was happening, but other colleagues
wouldn't”.
P23(M): “I think possibly the monitoring using cameras, it's more intrusive of
privacy, but there again I think if the user is in control of implementing
such a thing then you are doing it for your own benefit ... but I think,
again, it depends how it is implemented and about the understanding
that people are given”

Whilst for others, they would reject such encroachment:
P21(F): “I have concern for .... voice monitoring, eye gaze eyesight, facial
expression, even ... because you really do need a lot of detail to
identify those. Upper body, seated position, head position ... you still
need to see me, but they could have less detail, I suppose, so it could
be more anonimised. So, less concern, but still ....no. So, mouse and
keyboard use or position ... but it's just annoying, I don't want it telling
me that. I don't want it telling me that I am hitting something to hard ...
maybe I am, but not being a typist either, so maybe if I was typing
loads of stuff, but its just .... no”.
P30(F): “I would have privacy issues with both the above (emotion and posture
monitoring) because the data could be used by insurance companies,
potential employers, existing employers, hospitals, and if it was shown
that I had ignored advice this would be detrimental to me because they
might refuse to pay out on a claim or employ me, oh all sorts of things”
3.2.7 Self
Despite survey participants reporting that they felt able to self-manage, a

common theme for interviewees was lack of self-awareness and/or self-
confidence. They felt unable to trust their own judgment in terms of managing
well-being:
P1(F): “I resent the fact that my own shortcomings in managing my working

environment over the years and lack of attention to symptoms or even
lack of realising there were any, have put me in a position now where
some of the things I do at work have a direct negative impact on what I
do away from work”
P2(F): “(a) coping strategy would just be I suppose, changing posture, but
then that's already when you have noticed that you have the strain
somewhere so as much as it is beneficial it is not really because you
have already incurred the strain so it's only beneficial for a time
afterwards”
P14(F): “ ... even though I am aware that I need to sit differently it is not always
easy to remember to notice that you are not”
P31(F): “You know, you asked me if I'm comfortable and I am never aware if I
am comfortable or not. It's almost like I don't know what comfortable is.
As soon as I consider the question I almost become uncomfortable
just from that thinking process, so I am never sure what is really what”
3.2.8 Perception of Risk
With the photographic images used at the end of the interview, it had been
anticipated that participants with physical symptoms would rate risk from

posture-related images more highly than those participants without related
symptoms; and visa verse for images selected to engender feelings of stress.
Analysis of the comments and risk ratings revealed no correlation between the
nature of image and reaction to risk in terms of reported symptom experience.
Consequently, no further consideration was given to this element of the study.
3.3 Validation
3.3.1 Stage 1 (Survey)
As the participants had completed the surveys themselves it was not necessary
to seek validation on their responses.
3.3.2 Stage 2 (Interview)
All interview participants received copies of their transcripts in order to verify

validity. This also provided participants with the opportunity to provide post-
interview comments. Comments received were factored into the coding process
before final themes were identified.
Participants quoted in the paper received copies of Section 3.2 and were asked
to verify that their views had been accurately represented. One modification was
requested.

4. Discussion
Analysis revealed that experience of symptoms does not necessarily mean that
individuals readily welcome intervention (Nieuwenhuijsen, 2004). Potential
barriers exist that may prevent users from accepting CIMS as a part of their MSD
intervention program. Trust was identified as a gateway to acceptance (trust of
technology; CIMS method(s); and the employer); with “Purpose” (of CIMS),
“Autonomy”, and “Privacy” closely linked to the individual‟s ability to trust CIMS
and employers‟ deployment of it. In addition, the individual must be able to trust
her/his self. These five potential barriers need to be considered, and where
necessary addressed, in order for the individual to be in a position to make an
informed decision whether or not to become a CIMS user.
This chapter will consider each barrier, relating these barriers and the ethical
factors that surround persuasive technologies to current literature, before
introducing a CIMS User Acceptance Model.
4.1 Ethics in Persuasive Technology
Some of the themes and concerns raised by the study participants surround
ethical use of CIMS. When captology and persuasive technology were in their
infancy, Berdichevsky and Neuenschwander (1999) considered the placement of
“ethics” and “technology” by imposing them on to Fogg‟s diagram of captology
(Figure_9).
Figure_9: Convergence of ethics, persuasion and technology

(Berdichevsky and Neuenschwander, 1999)
More recently researchers have sought to define what ethics means to the user.
Kelly (2006) declared that he would accept technology if three out of the
following four conditions were met:
 “I know what information is being collected, where, why and by whom
 I assent to it either implicitly or explicitly and I am aware of it
 I have access to correct it, and can use the data myself

 I get some benefit for doing so (recommendations, collaborative filtering, or
economic payment)”
On first inspection, these conditions appear to relate closely to the potential

barriers identified by the interviewees, but individuals are often inconsistent.
Whilst some participants stated that privacy and trust did not factor highly in their
view of CIMS per se, they, along with the other participants, emphasised their
wish to be in control of the data. This may be interpreted as a wish for privacy
and possible lack of trust in colleagues and employer. As a result, it is necessary
to delve deeper into the specific ethical issues raised by the study.
4.2 Trust
Whilst some persuasive technologies may have a positive purpose, they can
negatively intrude into the lives of the users. Technological trust may be
influenced by a range of beliefs, attitudes, intentions, culture, knowledge of world
states, as well as the technology user‟s behaviour. Worldviews differ amongst
individuals colouring attitudes towards risks and benefits. By understanding what
trust means to potential users technology developers may gain greater insight
into the users‟ needs and wishes.
4.2.1 Trust in Technology
The Chambers Twentieth Century Dictionary‟s definition of trust is: “worthiness

of being relied on; confidence in the truth of anything” (Chambers, 1975). In
technical terms it was these two aspects which were identified as being of
concern to the study participants:
 Worthiness of being relied on:
– Will the technology be fit for purpose?
– How likely is it to break down?
– Are some monitoring and detection methods more error prone than
others?
 Confidence in the truth of anything:
– Are some monitoring and detection methods more capable of being
accurate (truthful) than others, and if so, how/why?
Trust is temporal in nature. It takes time to build and it must exist before
technology may be fully adopted and utilised. Whilst users may develop a
degree of trust in the infrastructure of technology over time, e.g. hardware and
mainstream software applications, potential CIMS users need to be assured that
the new system is trustworthy; that there is no difference between capability and
reliability. Trust is, however, not synonymous with user acceptance. Miller
(2005) purports that trust should be tuned to result in accurate usage decisions.
When considering trust and automation, where automation is “information

technology that actively transforms data, makes decisions, or controls
processes” (Lee and See, 2002), Lee and See (2004) describe a conceptual
model of the dynamic process that governs trust and its effect on reliance. The

model identifies three levels of information which the operator (in the CIMS case
this would be the user) needs in order to develop trust:
 Purpose: why the system exists
 Process: how the system works
 Performance: what the system has done
These levels are the “how”, “why” and “what” knowledge requested by interview
participants 16 and 17 before they felt able to comment on the trustworthiness of
any given CIMS.
4.2.2 Trust in CIMS Methods
The quality and relevance of the technology‟s ability to gather data and draw
correct inferences will influence trust (Ijsselsteijn et al, 2006). Fairclough (2009)
emphasises how the sensitivity of a monitoring method is “a vital attribute” in
enabling the system to respond appropriately, e.g. being able to distinguish low
levels of frustration from high levels of frustration.
As was shown by the trust ranking of example CIMS (Table_12 and

Appendix_7), the participants ranked physical CIMS (equipment use and
posture) more highly than affective measures. The low trust ranking of affective
CIMS may be explained by the participants‟ lack of experience of such
technology. If one does not understand the purpose of the technology (the what,
why and how of it); if one feels that technology may reduce one‟s autonomy, or
that it may encroach on one‟s privacy, then the perceived risks involved may
result in a lack of trust in that technology. With no background knowledge of
emotion recognition techniques, participants could only rely on affective
information, i.e. does the system please or displease? If I do not like something
then I may find it harder to believe that it has my best interests at heart. Trust will
be lacking.
Participant 31 questioned how CIMS would be able to accurately detect her

emotion-state better than she knows herself. Mismatches between user and
system perceptions of a physical or emotion-state may result when the system
fails to detect a state/change which has been perceived by the user or when the
system detects a state/change which is imperceptible to the user (Fairclough,
2009). In both circumstances trust is tested.
Whilst participants with experience of symptoms wished to become comfortable

in the physical sense, they did not want CIMS to make them uncomfortable in
the psychological sense.
“the critical challenge is to calibrate trust

to encourage appropriate reliance”.
Lee and See (2002)
4.2.3 Trust in the Employer
A Harris Poll (Taylor, 2003) found that the largest decline in privacy concern was
found among those who felt that “not being monitored at work is extremely

important” with the figure falling from 65% in 1994 to only 42% in 2003.
Ubiquitous employee monitoring is now possible, and this may explain the drop.
Measures include: computer use (keystroke tracking, email and Internet site
usage); telephone monitoring; video surveillance, employee ID card location
tracking. Employee monitoring may be transparent or covert. Workplace
monitoring and surveillance may be disliked by employees, but generally
tolerated as a part of the terms of employment (Charlesworth, 2003).
As reported by Participant 21, existing employer mistrust may, however,

undermine potential acceptance of CIMS, e.g. declared social values, mission
statement must match employer actions in order to engender trust from
employees (Strebel, 1996).
4.3 Purpose
Study participants had a pragmatic awareness that employers may not have the
resources to provide one-to-one DSE assessment of need and so interventions
such as CIMS may be considered as part of the overall approach to meeting
DSE Regulations and achieving employee well-being.
4.3.1 Consultation
“There would be no need to trust ..... any system whose workings

were wholly known and understood” (Raab, 2007).
Users need to understand how CIMS works in order to appreciate the range of
manipulations they may be subjected to (Fairclough, 2009). In order to
understand CIMS and be able to make an informed decision as to whether to
accept or reject its use, participants wanted to know more about the system(s);
what it was, how it worked and why it might be introduced.
By law employers must consult their employees on health and safety matters
(Health and Safety Executive, 2008), but not on all monitoring measures; unless
their use falls under specific legislation such as the Data Protection Act 1998 or
Human Rights Act 1998. The definition and purpose of CIMS is therefore vital to
the consultation process. The study has shown the participants‟ overwhelming
view that CIMS should support well-being and so CIMS must be placed in the
health and safety bracket.
Consultation should foster understanding and trust through system transparency

and employer accountability. Lack of consultation may result in individuals being
at a disadvantage if they do not fully understand the data acquisition system
(Shapiro and Baker, 2001). As a result of lack of consultation on prior occasions,
Participant 21 reported that she and her colleagues would try and find ways
around CIMS and posed the question: at what point would she decide that it is
too much and leave (her job). These views are supported by studies that have
identified loss of trust and deterioration of working relationships as an outcome
of workplace surveillance. Disaffected employees may undermine employers‟
plans (Strebal, 1996; Morrison, 2006). As Participant 21 points out, if CIMS is

viewed as a management tool for checking up on staff, rather than a user
support tool to foster well-being, then resentment/cynicism may ensue, if not a
complete rejection of CIMS (Morrison, 2006). Morrison‟s study indicated that
individuals involved in technology change decision-making reacted more
positively to change than did individuals with low levels of involvement.
4.3.2 CIMS as a Emotion-state Changer
79% of survey participants reported never using an ergonomic, work or

symptoms-based break utility (limited version of CIMS). This high proportion may
go some way to explain why CIMS that incorporated known aspects, e.g.
posture/equipment use, were perceived as being more acceptable than those
that involved emotion recognition, for which participants had no frame of
reference. Several questioned whether a system should be allowed to try to
change the user‟s emotion-state (Zimmermann et al, 2003).
4.3.3 CIMS as a Social Actor
Participant 1 reported that working alone, without social contact and feedback
provided from colleagues on how long she had been working, was a factor in her
own inability to manage her work/break habits. Ergonomics programs often
advocate Buddy Systems which enable colleagues to share information about
health and safety and so help foster a supportive environment (Ostrom et al,
2000). Use of CIMS as a social actor could provide lone workers with the benefit
of social support that a colleague might ordinarily supply (Olsen and Kraft, 2009).
CIMS ability to provide feedback will help the user know what to do in order to
make change. An archive facility enables her/him to review whether the
change(s) make any difference (Gravina et al, 2007). These facilities may help to
improve self-efficacy (perceived capabilities to attain specific goals or task
outcome).
4.4 Autonomy
Persuasive technology is a category of technology which is intentionally

designed to change an individual‟s attitude or behaviour. Ijsselsteijn et al (2006)
emphasised that persuasion implies a “voluntary” change of behaviour, attitude,
or both. The voluntary aspect came through strongly in this study, where
participants repeatedly spoke of their wish for autonomy.
4.4.1 Choice
The individual‟s ability to choose whether or not to use CIMS closely relates to
knowledge of its purpose and so will, in part, result from the consultation
process; which engenders empowerment and ownership. Without the
consultation process/knowledge of purpose, the ability to make a rational choice

diminishes. Choice also relates to control, with perceived control directly
associated with higher satisfaction (O‟Driscoll and Beehr, 2000).
4.4.2 Control
Most participants stated their requirement to configure CIMS to meet their

personal and work needs; adjusting them on a task-by-task, or day-by-day basis
as necessary. Being in control was imperative for most participants. This need is
supported by several studies and papers on the subject of persuasive
technology (Picard and Klein, 2002; Fairclough, 2009).
Another justification for user control was put forward by Participant 17, who
described stress as a motivator, “feel of adrenaline”. She questioned whether
CIMS should report stress in all circumstances. Rickenberg and Reeves (2000)
support this view stating that some arousal may be useful to determine what we
do, how we channel focus/attention. Participant 17 would be more concern if
stress levels did not reduce once a deadline/task had passed.
Identification of stress/frustration was a factor raised by several participants, who

felt that they were better placed to identify how they felt than “a computer” could
be. They would prefer to have that aspect of their emotions within their own
control; a view supported by Reynolds and Picard‟s study (2001). Computers
can very easily induce negative affective states in human users, such as
frustration, anxiety and anger. Mainstream technology‟s inability to rectify these
negative states may impede productivity, creativity and cognitive capacity
(Mentis and Gay, 2002). Apart from Participant 23, who would want the system
to provide solutions to problems he encountered, the participants could not see
past the fact that they did not want their computers informing them of their
emotion-state. Consequently, they could not effectively consider how the system
might provide advice/guidance on overcoming technical issues.
Tailoring CIMS approaches to the attitudes, beliefs and knowledge of the user
may enhance likelihood of increased well-being through the system-
recommended change being implemented (Whysall et al, 2007). One example of
this can be seen in terms of system feedback format, where participant
preference was quite varied. Studies have shown that where feedback is tailored
to reflect individual requirements/preferences relevance is increased, making it
easier for the user to comprehend and remember (Fogg, 1999; Dijkstra, 2006).
Providing the user with the ability to customise CIMS may result in increased
positive behaviour change.
4.5 Privacy
Westin (1970, p7) asserts that privacy is:
“the claim of individuals, groups, or institutions to determine for

themselves when, how, and to what extent information about them is
communicated to others”.

Privacy is a personal concept, with worldviews differing between individuals or
even for the same individual under different circumstances. Influencing factors
may include experience and context. Privacy decisions are often based on
judgement rather than fact, as individuals rely on weak mental models and
heuristics. In group situations such as the workplace, an individual users‟ privacy
preferences may be influenced by social norms/group behaviour.
When asked about their attitude towards privacy, most participants initially
reported that it was of little concern to them; this despite previously voicing
concerns over data access rights, which implies issues with privacy control.
Participants‟ initial inability to perceive privacy issues with CIMS may be related
to analogical trust of the researcher, i.e. prior knowledge of the researcher
deemed her as trustworthy and that trust transfers to CIMS (Raab, 2007). As the
interview developed deeper into what might constitute privacy, participants
reported the following concerns/expectations with regards to CIMS:
i. That feedback from the system should not alert colleagues to potential
problems, which might result in embarrassment for the user (privacy as
personal dignity)
ii. That data may be taken out of context
iii. The potential to be identified through data held by the system, e.g. video
images, voice recordings (privacy as anonymity)
iv. That data recorded should be securely stored (security) and used
appropriately (support the employee); not mis-used
The first two points are perhaps more easily addressed. Point (i.) through CIMS
compliance with autonomy, as the user would be able to adjust the settings to
meet her/his privacy preferences, i.e. provide discreet text/symbolic messages
(Fairclough, 2009). Picard and Klein (2002) argue that control of the monitoring
function should always lie with the user. If data is taken out of context, point (ii.)
then there is the potential for discrimination if the individual is included in a
particular profile/classification. Providing context which the user may update
should s/he wish (proposed by Participant 15), may help to address this concern
(Bullington, 2005; Fairclough, 2009).
Points (iii.) and (iv.) fall under the category of data privacy; the expectation of
privacy in the collection and sharing of data about oneself. Concerns exist where
uniquely identifiable data relating to the individual are collected and stored.
Fairclough (2009) reported that “a technology designed to promote symmetrical
communication between user and system creates significant potential for
asymmetry with respect to data protection, i.e. the system may not tell the user
where his or her data are stored and who has access..”.
Participants voiced concerns over who would be given access to the information
and under what conditions. Ownership of data, i.e. does the individual own rights
to data, have rights to view, verify, change or challenge the data. The European
Union requires all member states to legislate to ensure that citizens have a right
to privacy. In the UK this is regulated by the Data Protection Act 1998. The Data
Protection Act gives individuals the right to know what information is held about
them; providing a framework to ensure that personal information is handled
properly (Information Commissioner, 2009). Such controls are designed to

ensure that consensually gathered information is not used in ways that do not
relate to the original grounds for consent.
Privacy protection may be seen as a risk-management device; with the level of

trust in technology reflecting the degree of trust in risk management (Raab,
2007). Existing mistrust of an employer led participants to lean towards mistrust
of CIMS. Achieving transparency with CIMS is key. So that whilst employers may
know more about the users through the user of CIMS, the users should be fully
aware of what the employers know and how that information will be treated.
Palen and Dourish (2003) argue that what is important is not what the
technology does, but rather how it fits into cultural practice. Privacy management
is a dynamic entity with, as the study participants demonstrated, individuals
responding to circumstances as they are presented rather than applying static
rules. An individual‟s need for privacy, if considered in isolation, may threaten
their chances of increasing their well-being, i.e. if the user‟s privacy needs are
met then s/he is more likely to accept CIMS and so benefit from it, whereas if
privacy needs are not met then the user is more likely to reject CIMS and so lose
any benefit it may bring. As individuals often rescind their right to privacy where
rewards may be gained (Acquisti and Grossklags, 2005), privacy concerns may
be balanced with the other barriers identified by the study. Consequenly, CIMS
should not be seen as an instrument through which privacy concerns are
reflected, but part of the wider circumstance within which the concerns of the
individual are formulated and interpreted.
4.6 Self (the “user”)
As well as considering the potential barriers discussed above, perhaps more

importantly, the user must consider her/his self; the degree to which one may
understand and trust oneself. An individual‟s self-efficacy will feed their self-
confidence; a critical factor in the decision-making process (Bandura, 1983).
Several participants declared awareness of own limitations. For those
participants who reported a lack of self-awareness, they might trust CIMS to
report problems and prompt for action more than they would trust themselves.
For those individuals who posses self-awareness, they felt able to interpret what
CIMS was reporting and know whether or not to trust the advice given.
As with trust, decision making is based on an individual‟s attitudes, beliefs,

culture. These aspects have the capability of changing over time based on
knowledge acquired through new experiences. User acceptance of CIMS is not
simply a matter of achieving trust. There must be a willingness to accept advice
and change behaviours and resistance to change is common (Neumann et al,
1999). Participants had a pragmatic awareness that their employer was unlikely
to have the resources to review all CIMS logs. Working in partnership with CIMS,
the individual would need to take ownership for her/his own well being.
Employee behaviour may be seen as one of the greatest determinants in
workplace safety (Gordon, 2003). As one participant reported, future
consequences of behaviour are easily ignored in the present, e.g. continuing to
work on a piece of work, even though a break is due, only to “hurt” later on. The

ability to shift between different behavioural strategies is necessary for
appropriate change behaviour decision-making.
When considering health-related behaviour change, Niewenhuijsen (2004) found

that self-efficacy and “intention to change” demonstrated a positive relationship
with health-related behaviour change. According to the Stage of Change model
(Prochaksa and DiClemente, 1982) an individual‟s readiness for change will be
different from her/his neighbours; with each person‟s ability to change taking
place according to where s/he is within the various model stages:
(pre(contemplation)), preparation, action, sustaining/maintaining health
behaviours. This starts to explain the varied responses provided by participants.
Montgomery (2004) defines wellness as a combination of factors, which include:

 Physical wellness, which entails personal responsibility and care for minor
illnesses and knowing when professional medical attention is needed
 Emotional wellness, where one recognizes awareness and acceptance of
one‟s feelings and the degree to which one feels positive and enthusiastic
about oneself and life
 Occupational wellness, which recognizes personal satisfaction and
enrichments in one‟s life through work.
CIMS adoption is more likely to succeed if the individual is able to recognise

strengths and weakness in her/his self and make sense of how CIMS may
support these personal traits in the promotion of wellness. In order to take
ownership, where individual attitude and behaviour play a vital role (Gravin et al,
2007) the individual needs to be self-aware and self-confident. Both are skills
that most participants appear to be lacking.
4.7 The CIMS User Acceptance Model
The study found that a variety of physical, psychological and psychosocial

aspects impact on an individual‟s potential for acceptance of new technology and
the change it brings. Take up of an intervention such as CIMS requires the
individual to be ready to accept a desirable lifestyle change (Nakajima et al,
2008). The Stage of Change model, which is cyclical in nature, identifies an
individual‟s readiness for change. Each person‟s ability to change and stage
position will be dependent on attitudes, beliefs and current knowledge. Table_13
shows each stage and definition identified by Whysall et al (2007).
In terms of readiness, the Stage of Change model is one way by which the
individual‟s potential for CIMS acceptance may be considered (Whysall et al,
2007). It works for Participant 21 who is not prepared to follow ill-health
preventative advice and may be firmly placed at pre-contemplation. According to
the other participants in this study the model does not tell the whole story.
Whysall et al (2007) found worker stage of change may be unrelated to their
perceived cost-benefit of MSD intervention. It is this very individualism of the
user which is at the centre of any health-related behaviour change.

Stage of Change Definition
Pre-contemplation Not intending to reduce the risk
Contemplation Intending to take action in next six months
Preparation Intending to take action in the next 30 days;
and/or have developed specific plans for the
steps that are to be taken
Action Working to reduce risk
Maintenance Having taken action more than six months ago;
and are working to consolidate the gains made
and prevent relapse
Relapse Definition not provided
Table_13: Stage of Change Model Definitions (Whysall et al, 2007)
For persuasive technology an additional aspect of acceptance is involved. CIMS

monitors the individual in order to encourage a voluntary change in behaviour.
Being ready to accept change does not mean that the individual is prepared to
accept any/all change. Study participants have indicated that they might be
ready to accept CIMS based on posture detection, but not emotion-state; that
posture measured by equipment position, body/head distance from the computer
screen would be acceptable, but use of cameras would not (Table_14).
THEME EXAMPLES of READINESS to ACCEPT CHANGE

Trust  Ready to accept what I know and understand, e.g.
physical aspects or position, posture, equipment use
 Not ready to accept what I do not know or understand,
e.g. emotion-state measurements
Purpose  Ready to accept a system which will support me in my
attempts to improve my well-being
 Not ready to accept a system which might be used
against me
Autonomy  Ready to accept a system which I can adjust as my
personal and work needs dictate
 Not ready to accept a system which takes over or
which is controlled remotely by others
Privacy  Ready to accept a system which will maintain my
privacy, e.g. silhouette of my upper body to show
posture
 Not ready to accept something which invades my
privacy, e.g. video surveillance
Self  Ready to accept a system as I am aware of my own
shortcomings which prevent me form managing my
own well-being
 Not ready to accept a system as I do not want it; do
not believe I need it
Table_14: Examples of readiness states for CIMS

Following the user-centred approach taken by HCI, a CIMS User Acceptance
Model is proposed which places the “user” at its centre, so that each user may
be treated as an individual.
Technology user acceptance models already exist, so why present a new one?
Previous models, such as the Technology User Acceptance Model (TAM)
(Davies, 1989), identified “perceived usefulness” (the degree to which a person
believes that using a particular system would enhance his or her job
performance) and “perceived ease of use” (the degree to which a person
believes that using a particular system would be free from effort) as factors in
user acceptance. A study by Venkatesh et al (2008) found negative association
with behavioural intention of using technology, i.e. if the user perceives the
technology as being difficult to use, then s/he is less likely to have a positive
attitude towards the concept. With regards to CIMS, apart from Participant 21
who flatly refused to countenance use of CIMS, the participants could all see the
potential for “usefulness” of CIMS, but “ease of use” was not raised by any of the
study‟s participants; this finding is supported by other studies (Keil et al, 1995;
Hu et al, 1999). Usefulness on its own does not explain the attitudes expressed
by the participants as to whether or not they would accept CIMS.
More recent studies have found that the type of technology impacts user attitude
and usage (Curran et al, 2005; Im et al, 2008). Due to the variety of influencing
factors involved, e.g. perceived risk, a sub-construct or antecedent of trust (Im et
al, 2008), attitudes towards different technologies used to deliver the same
service are discrete from each other. Whilst the identification of risk starts to
explain the findings of the present study, it does not go far enough. The present
study confirmed that technology cannot be viewed as a single homogeneous
group when considering user acceptance.
Whilst Nieuwenhuijsen (2004) found that process of health behaviour change is

interactive, he found no significant relationship between knowledge of ergonomic
risk factors, awareness of preventative activities and health behaviour change.
Knowledge may influence choices in behaviours and actions, but it is not the
most important variable influencing an individual‟s behaviour change (Haslam,
2002). As such, knowledge of CIMS, with regards to its purpose, scope of
autonomy and approach to privacy is insufficient.
Taking the issues that surround persuasive technology into account, and by
applying the participants‟ themes to CIMS, the CIMS User Acceptance Model is
proposed. With trust as its bedrock, the model identifies purpose, autonomy, and
privacy as potential barriers to acceptance. At the core of the model is the user
(the individual, the self), who must not only establish her/his level of trust in
CIMS through interpretation of the barriers, but also consider how far s/he can
trust her/him “self” in coming to that decision (Figure_10 and Table_15).
Each potential user must be provided with sufficient information about CIMS and
its intended implementation in order to understand and interpret each of the
barriers as they may apply to her/him “self” (attitudes, beliefs, behaviours). This
will establish to what degree s/he trusts before acceptance may even start to
take place.

Figure_10: CIMS User Acceptance Model
Potential
Barrier Definition Themes
User Individual who is a work-based computer Individual
user Self
Purpose A system designed to support the individual What, why
in the prevention/reduction of MSDs and how
Autonomy Providing the user with the ability to: Control
 choose when/if the system is used Choice
 control the system by configuring each
element to meet her/his personal and
work needs
Privacy Ability of the system to protect the user‟s
Security
data/identity to the user‟s satisfaction Who, how,
when
Trust The degree to which the user believes that Accuracy,
the system, its purpose and configuration, Agreement,
and those who support her/his use of it may Misuse,
be relied upon Relevance,
Reliability
Table_15: Components of the CIMS User Acceptance Model
For the individual to achieve successful adoption of persuasive technologies

such as CIMS s/he needs to appreciate the potential benefit, be willing to change
and be supported through the change process (Haslam, 2002). Beyond initial

acceptance, study participants raised practical concerns, similar to the questions
posed by Ijsselsteijn et al (2006):
 they would want the technology to be subtle, rather than irritating or
controlling
 they do not want to be frequently interrupted or continually receive the same
feedback
 incorrect inferences, improper feedback, or bad timing may be tolerated, but
for how long?
Before Participant 31 is able to enter into a “contract” with CIMS, these and other
practical concerns need to be addressed. True levels of acceptance may only be
known if CIMS is developed and computer workers use it.
4.8 Study Limitations
4.8.1 Self-reports
The HSE (2009) notes that whilst its figures come from self-reports and so “are
not an exact measurement of the true extent of work-related illness”, such self-
reports provide a reasonable indicator as they have previously confirmed
through “high levels of agreement between individuals and their general
practitioners” (GPs), with agreement being particularly high for cases of self-
reported stress, depression or anxiety and MSDs. This observation is supported
by studies such as that conducted by Deyo and Diehl (1983). As the majority of
survey participants were known to the researcher, the self-reports provided by
the survey could be verified through contact history, client case notes, and
further interrogation at the interview stage.
4.8.2 Project Timing, Participation and the Potential for Bias
At the project planning stage it was envisaged that the survey would be
conducted during May and June of 2009. Due to unforeseen circumstances, the
survey was delayed until July, by which time many of those who had declared an
interest were no longer available. This reduced the sample size, the industry
sector spread and number of participants without symptom experience.
Consequently, the participants of this study do not represent a randomly
selected sample of work-based computer users.
4.8.3 Stage 1 (Survey)
The combination of purposive and convenience sampling methods used was

designed to ensure an even distribution of males to females, industry types,
known symptoms (known to the researcher through prior discussion or
professional involvement) versus no known symptoms. The survey reach and
feedback received was significantly skewed in some areas. For example, from
the purposive sampling, 75 females and 20 males were canvassed. A potential
population of 100+, predominantly males, should have been reached via the
employer/group representative survey. Non-availability of primary contacts

meant that invitations were not passed on within a suitable timeframe. Only 10
participants were found using this method (8 females and 2 males). The small
sample size may have resulted in bias as more females than males (28:10) took
part in the survey. When considering participants experience of symptoms, 34
reported symptoms compared to 4 without.
4.8.4 Stage 2 (Interview)
Whilst there was a potential interview pool of 31, availability prevented

participants from taking part who as a result of their survey feedback might have
provided insightful comment.
4.8.5 The Hypothetical Nature if CIMS
As CIMS does not yet exist, participants may have swayed their responses in
favour of known aspects, e.g. posture/equipment use were perceived as being
more acceptable than those which involved emotion recognition, for which
participants had no frame of reference.
4.9 Future Studies
Whilst the study has begun to answer the questions that surround user
acceptance of CIMS, many remain unanswered. Some of these may offer
opportunities for further research.
4.9.1 Potential Bias
4.9.1.1 Gender
Berkley (1997) found that sex differences in attitudes exist that affect not only
reporting, coping and responses to treatment, but also measurement and
treatment. At interview stage the female to male ratio was 11:2. Whilst the
comments of the two male interviewees were in line with those of the females,
repeating the study with a greater male population would confirm if gender bias
had any part to play in the study outcome.
4.9.1.2 Industry Sector
When considering implementation of the Stage of Change Model, Whysall et al

(2007) found private versus public-sector differences in their study. Participants
in the study were predominantly from the charity / not for profit sector. Repeating
the present study with a greater spread of industry sectors would confirm if
sector bias had any part to play in the study outcome.

4.9.2 Adaptations of CIMS and the User Acceptance Model
The study asked participants to considered multi-factorial CIMS; systems that

would monitor posture and emotion-state, utilising a variety of monitoring
methods. Further investigation would be needed in order to establish whether
the barriers within the CIMS User Acceptance Model remain relevant for each of
the possible uni-factorial CIMS and monitoring methods, e.g. monitor posture,
but not emotion-state; use of keyboard use, but not cameras and so on.
4.9.3 Applying the Model to Other Persuasive Technologies
By separating the user acceptance variables identified in this study from CIMS
(Figure_11), they may be applied to other forms of persuasive technology.
Further research would be needed in order to establish if all of the variables
remain potential barriers for different types of persuasive technology.
Figure_11: Persuasive Technology User Acceptance Variables
4.9.4 The Employer‟s Viewpoint
Im et al (2008) reported that managers should “try to convince users that it

(technology) is of value”, by emphasising the benefits involved. CIMS
acceptance was considered only from the users‟ perspective. Employer attitude
towards CIMS would need to be considered in order to identify correlation and/or
differences that might inform management strategies and/or design (Ouadahi,
2008).

5. Conclusion
Despite high numbers of UK workers experiencing work-related musculoskeletal

and stress-related disorders (HSE, 2009), current legislation and intervention
practices do little to stem the tide of these conditions. Studies have shown that
work-based computer users need regular support in order to comply with MSD
prevention programs, such as those that promote work rest and stretch breaks
(Monsey et al, 2003).
The purpose of this study was to investigate work-based computer users‟

attitudes towards the prospective persuasive technology of computer-based
interactive monitoring systems (CIMS); where attitude may influence user
acceptance of CIMS (welcome, tolerate or rejection). The perceived purpose of
CIMS would be to promote work-based computer user health and well-being by
monitoring and detecting risk(s) and providing advice on remedial actions in
terms of the user‟s emotion-state, posture and work habits. It is not envisaged
that CIMS would replace other forms of legislative compliance, but should be
seen as a part of a larger toolkit of interventions, policies and personnel with
which the user collaborates to achieve and maintain well-being.
Successful implementation of health and safety programs requires collaboration.

Traditionally, that has meant employers, employees and professionals (e.g.
ergonomists, occupational health officers, health and safety representatives)
working together towards a common goal, such as the reduction and prevention
of computer-related ill health. Developments in technology, the user-centred
approach taken by HCI and the scope of persuasive technologies, means that
today technology can play a part in the collaborative venture.
The potential for persuasive technologies to motivate, stimulate and even

convince workers to avoid bad work habits/posture and adopt good ones means
that they have the potential to play a key part in the prevention/reduction of
MSDs and stress. By utilising persuasive technology, CIMS may be able to
facilitate a positive change in its users (Nakajima, 2008). For health-related
behaviour change interventions such as CIMS to be realised, it is vital that
knowledge about user behaviour and what facilitates health-related behavioural
change is used to feed the design and evaluation of such persuasive
technologies (Michie, 2008). For users to benefit from persuasive technologies
such as the proposed CIMS they must be willing to adopt and integrate the
intervention into their work routines and behaviour (Whysall et al, 2007). Just as
MSDs are multi-factorial in nature, emotion and stress can also be the result of a
combination of factors. Herein lies the challenge for the ergonomist and for
CIMS.
Analysis revealed that experience of symptoms does not mean that individuals
readily welcome intervention. A combination of knowledge, understanding, and
trust is required; in CIMS and all that it entails. From thematic analysis, five
potential barriers to user acceptance were identified: self (the user), purpose (of
CIMS), autonomy, privacy and trust. As represented by the CIMS User

Acceptance Model, through consideration of these barriers each potential user
should be provided with sufficient information about CIMS and its intended
implementation in order that s/he may interpret each of the barriers as they apply
to her/him “self”. This process establishes the individual‟s ability to welcome,
tolerate or reject CIMS.

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Appendix_1
Invitation to Participate in Research Project Survey

Dear
I hope this finds you well?
As you [ know / may know ], I am currently studying for an MSc in Human

Computer Interaction with Ergonomics at University College London (UCL) and
have reached the research project stage. I am looking for study participants and
wondered whether you would be willing to take part? Please be assured that
you are under no obligation to take part in the study; participation is entirely
voluntary and you are free to withdraw from the study at any time. Confidentiality
and anonymity will be maintained and it will not be possible to identify you from
any publication.
The project poses the following question: “If your work-based computer could
warn you that you might be putting yourself at risk (through posture, work habits
and/or changes to your emotional-state) would you want it to?” The first stage of
the study is a survey; a copy of which is attached (MS Word format).
Please do not hesitate to contact me should you have any questions regarding
the study or survey.
I look forward to hearing from you.

With thanks,
Jan

Appendix_2
MSc Human Computer Interaction Research Project

- Survey
Contains copy of the project “Information Sheet”

MSc Human Computer Interaction Research Project - Survey
My name is Jan Mulligan. I am studying at University College London (UCL) for

an MSc in Human-Computer Interaction with Ergonomics and am currently
conducting research into the attitude of work-based computer users to risk. The
study considers whether:
“If the computer could warn you that your working habits,
posture, and/or emotional state might be putting you at risk of developing or
aggravating symptoms,
e.g. stress, headaches, eyestrain, physical discomfort,
would you want it to and, if so,
what monitoring methods would you find acceptable?”
I am looking for study participants and would be grateful if you would take part by
completing the attached questionnaire; it should take about 20 minutes. You are
free to skip questions which you do not wish to answer or to stop at any time;
there is no need to give a reason. You will see that the survey asks you to
provide your contact details (name and email address and/or telephone number);
this is so that I may invite some participants to take part in a more in-depth
interview process. Completing the survey does not, however, oblige you to take
part in the interview stage. Again, you are completely free to decline to take part
or to stop at any time.
Please be assured that outside of the correspondence between us your

confidentiality and anonymity will be maintained; it will not be possible to identify
you from any publications.
The next page provides you with more information on the study, my contact
details and those of my project supervisors. Please do not hesitate to contact us
should you have any questions.
Thank you for your time.

Jan Mulligan
Email: j.mulligan@ucl.ac.uk

Information Sheet for Participants in Research Studies
You will be given a copy of this information sheet.
Title of Does attitude affect risk? Potential for user acceptance

Project: of interactive affect and ergonomic monitoring systems
This study has been approved by

the UCL Research Ethics MSc/0809/018
Committee [Project ID Number]:
Name, Jan Mulligan

Address and XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX,
Contact XXXXXXX
Details of Email: j.mulligan@ucl.ac.uk Tel: XXXX XXXXXXX
Investigators:
Rachel Benedyk
UCL Interaction Centre, MPEB 8th Floor, University College
London, Gower Street, London WC1E 6BT
Nadia Berthouze
UCL Interaction Centre, MPEB 8th Floor, University College
London, Gower Street, London WC1E 6BT
We would like to invite you to participate in this research project. Before you decide
whether you would like to take part, please read the following information carefully
and, should you wish, discuss it with others. Please feel free to ask us if there is
anything that is not clear or if you would like more information.
Details of Study
This is an exploratory study to consider work/office-based computer users‟ attitudes to
risk in the context of work-related computer use and their acceptance levels of
technology-based interactive affect and ergonomic monitoring systems to support the
prevention, reduction and possible recovery from symptoms which may be
exacerbated by computer use. The study aims to consider:
– If the computer could warn the user that s/he might be putting her/himself at risk,
would the user want it to?
– What risks would users want the computer to detect?
– What monitoring and/or detection methods would users welcome/tolerate/reject?
– What advice provision methods would users welcome/tolerate/reject?
– Are users influenced by previous or existing symptoms?
– Does work location have an impact on views?
The first stage of the study is the completion of a questionnaire. Based on your
feedback you may then be invited to take part in an interview. The venue for the
interview will be of your choosing. Ideally the interview will include a visit to your
workstation(s) so that your computer set-up and working posture may be observed
and, with permission, digitally recorded (photographed).
Participation
If you decide to take part in the survey you may skip any questions which you would
prefer not to answer. You are free to withdraw at any time; without giving a reason. All
data will be collected and stored in accordance with the Data Protection Act 1998 and
it will not be possible to identify you from any publication.

SECTION 1: General
This section asks about you, your job and your computer use.
 If you are completing the questionnaire on a computer, please make your

response(s) stand out by using the highlight or colour change features
 If you are completing the questionnaire by hand, please circle your
response(s)
 Please use the COMMENT space provided at the bottom of most questions
to provide any additional information which you feel may be relevant or which
allows you to explain your response more fully
1. Name:
___________________________________
2. Email address:
___________________________________
3. Telephone Number:
___________________________________
4. Gender
a) Female
b) Male
5. Age
a) 18-20
b) 21-30
c) 31-40
d) 41-50
e) 51-60
f) 61-65
g) Over 65
6. Job title:
___________________________________
7. Industry Sector:
a) Public
b) Private
c) Not-For-Profit / Charity
d) Other…. Please explain:

8. Employment category (Please select all that apply):
a) Full-time
b) Part-time
c) Employed
d) Self-employed
e) Contractor
f) Temporary worker, e.g. Agency staff
g) Other…. Please explain:
9. Contracted hours worked each week

a) 0-8
b) 9-16
c) 17-24
d) 25-35
e) 36+
COMMENT:
10. Overtime hours worked each week (whether paid or not)

a) 0-8
b) 9-16
c) 17-24
d) 25-35
e) 36+
COMMENT:
11. Length of time in current job:

a) Less than one month
b) Between one and six months
c) Between six months and one year
d) More than one year
e) More than two years
f) Five years or more
COMMENT:
12. Where is your primary workstation/desk location?

a) Single occupancy office
b) Shared occupancy office
c) Open plan office
d) Home-based office (room dedicated for work purposes)
e) Home-based workstation/desk (dedicated area of shared purpose room)
f) Home-based ad hoc set-up (set-up computer on work surface as needed
and pack away afterwards, e.g. kitchen table)
g) Other…. Please explain:

13. How long do your spend at your work computer across a typical day?
a) Less than one hour
b) Between one and three hours
c) Between three and six hours
d) Between six and eight hours
e) More than eight hours
COMMENT:
14. What might be the longest length of time you spend working at your
computer before taking a break, i.e. short break away from the
computer for telephone calls, paperwork, filing, photocopying, comfort
break?
a) Less than one hour
b) Between one and two hours
c) Between two and three hours
d) Three hours or more
COMMENT:
15. What style of computer do you have?

a) Desktop computer (base unit generally located at desk level or in cage
under desk)
b) Tower computer (base unit generally located under desk at floor level)
c) Portable computer (screen size of 14” or more)
d) Notebook computer (screen size of less than 14”)
e) Other…. Please explain:
16. What style of keyboard do you use?

a) Standard
b) Compact (e.g. does not have built-in number pad)
c) Ergonomic (e.g. adjustable, split style, vertical)
d) Specialist (e.g. industry specific, one handed, chorded)
e) Built-in (part of portable computer / notebook)
f) Other…. Please explain:
If you do not have a standard keyboard, please explain why, e.g. did you
inherit it, chose it, or was it provided for a specific reason?

17. What style of pointing device do you use?
a) Standard mouse
b) Ergonomic mouse (shaped to fit hand)
c) Ergonomic mouse (vertical)
d) Rollerball / Trackball (static device)
e) Graphics Tablet / Pen style
f) Handheld device
g) Built-in touchpad (part of portable computer / notebook; generally located
in front of the keyboard area)
h) Built-in Trackpoint (part of portable computer / notebook; generally
located between the G+H keys)
i) Other…. Please explain:
If you do not have a standard mouse, please explain why, e.g. did you inherit
it, chose it, or was it provided for a specific reason?
18. What style of monitor do you use?

a) CRT (chunky / TV-style / glass fronted)
b) TFT (flat screen / external)
c) TFT (flat screen / built-in to portable computer / notebook)
If you answered (a) or (b), how is the monitor mounted?

d) On its own fixed height stand
e) On its own height adjustable stand
f) On a modular-based stand (e.g. formed of one of more 1” or 2” blocks)
g) On a fixed height monitor stand
h) On a height adjustable monitor stand
i) On a monitor arm
j) Other…. Please explain:
If you answered (c), how is the computer mounted?

k) On the work surface (at desk level)
l) On book, telephone directory, box files or something similar
m) On a modular-based stand (e.g. formed of one of more 1” or 2” blocks)
n) On a fixed height monitor stand
o) On a height adjustable monitor stand
p) On a monitor arm
q) In a portable computer stand
r) Other…. Please explain:

19. How would you describe your typing style?
(Please select all that apply)
a) Touch typist trained (look at the monitor when typing)
b) Touch typist self-taught (look at the monitor when typing)
c) Semi-touch typist (regularly look between monitor and keyboard)
d) Non-touch typist (look down at keyboard most of the time and use most
fingers)
e) Non-touch typist (look down at keyboard most of the time and use two or
more fingers)
f) Non-touch typist (look down at keyboard most of the time and use one
finger)
g) One handed
h) Voice recognition, e.g. Dragon Naturally Speaking (DNS) (keyboard rarely
used, if ever)
20. Does your company provide you with Display Screen Equipment (DSE)
Workstation Assessments?
This the process by which the health, safety and comfort of each employee
who uses a computer may be considered; with appropriate action being taken
to rectify any problems identified
a) Yes
b) No
c) Don‟t know
COMMENT:
If you answered “No” or “Don’t know” to Question 20, please go to

Question 25
21. When was your last DSE assessment?

a) Within the past six months
b) Between six months and one year
c) Between one and two years
d) More than two years ago
e) Can‟t remember
COMMENT:

22. Who conducted the assessment?
a) I completed a printed form
b) I completed an on-line survey
c) Internal contact (e.g. colleague, line manager, DSE assessor, IT
Department, Occupational Health, Human Resources / Personnel etc.,)
d) External assessor / consultant
e) Can‟t remember
f) Other…. Please explain:
23. Did the assessment result in any changes to your furniture or computer
equipment?
a) Yes
b) No
c) Can‟t remember
If you answered (a) “Yes”, were the changes aimed at:

a) Helping with an existing symptom / injury
b) Preventing symptoms occurring
c) Don‟t know
COMMENT:
24. Did the assessment result in any recommendations for you to change
your working habits, e.g. vary your work tasks more frequently, take
more regular breaks from the computer, conduct stretching exercises,
etc.
a) Yes
b) No
c) Can‟t remember
If you answered (a) “Yes”, were the changes aimed at:

d) Helping with an existing symptom / injury
e) Preventing symptoms occurring
f) Don‟t know
COMMENT:
25. Have you ever used a work, ergonomic or symptom break reminder
utility such as: Break Reminder, MacBreakZ, RSIGuard, WorkPace,
WorkRave? These software utilities prompt the user to take a break and/or
conduct gentle stretching exercises
a) Yes
b) No
g) Don‟t know
COMMENT:

26. Do you have (or have you ever had) any symptoms which you attribute
to or which you believe may be aggravated by computer use?
Example symptoms include: headaches, eyestrain, aches, pains, numbness,
pins and needles, stress, tension, excessive tiredness
a) Yes
b) No
c) Prefer not to answer
If you answered (b) “No” or (c) “Prefer not to answer” to Question 26,
please go to:
Section 3 (Designing For User Need) – found on Page 13

SECTION 2: Symptoms
This section asks about any symptoms that you have (or have had in the
past) which you attribute to or which you believe may be aggravated by
computer use.
27. Which of the following statements describe(s) your symptoms….

a) Chronic (long-lasting, recurrent in nature)
b) Acute (recent, rapid onset, short-lasting)
c) Mild (not severe, but persistent)
d) Severe (intense, debilitating)
e) Build across the working day / week
f) Episodic (triggered by certain activities, postures, types of work, levels of
workload)
g) Occasional (no real pattern to when they occur or wear off)
h) Generally wear off overnight or across a weekend
i) Wear off only with rest, e.g. when take a holiday
j) Permanent: may change in intensity, but do not wear off
k) Historic (have had symptoms in the past, but have been symptom-free for
six months or more)
l) Other…. Please explain:
28. Please indicate which area(s) bother you (Please select all that apply)
a) Head (e.g. headache, migraine)
b) Eyes (e.g. hot, sore, tired, stinging, dry, weeping eyes; eyestrain)
c) Neck
d) Shoulder
e) Shoulder blade
f) Upper back
g) Lower back
h) Hips
i) Buttocks, coccyx or seat/sit bones
j) Thigh(s)
k) Knee(s)
l) Calf, ankle/Achilles‟ tendon, heal or foot
m) Upper arm
n) Elbow
o) Forearm
p) Wrist
q) Hand
r) Finger
s) Thumb
t) Joints
u) Stress or tension
v) Excessive tiredness
w) Other…. Please explain:

29. Please indicate which area(s) bothers you MOST (Please select just ONE)
a) Head (e.g. headache, migraine)
b) Eyes (e.g. hot, sore, tired, stinging, dry, weeping eyes; eyestrain)
c) Neck
d) Shoulder
e) Shoulder blade
f) Upper back
g) Lower back
h) Hips
i) Buttocks, coccyx or seat/sit bones
j) Thigh(s)
k) Knee(s)
l) Calf, ankle/Achilles‟ tendon, heal or foot
m) Upper arm
n) Elbow
o) Forearm
p) Wrist
q) Hand
r) Finger
s) Thumb
t) Joints
u) Stress or tension
v) Excessive tiredness
w) Other…. Please explain:
30. For the area which bothers you MOST, which of the following
describe(s) your symptoms (Please select all that apply):
a) Aching
b) Burning
c) Cramping
d) Discomfort
e) Dull
f) Nagging
g) Numbness
h) Pain
i) Sharp
j) Stiffness
k) Swelling
l) Tense
m) Tingling / pins and needles
n) Weakness
o) Other…. Please explain:

31. Have you discussed your symptoms with.... (Please select all that apply)
a) GP (general practitioner / your doctor)
b) Medical Consultant
c) Therapist (e.g. physiotherapist, osteopath)
d) DSE workstation assessor (or similar workplace consultant)
e) Counsellor
f) Line manager
g) Colleague(s)
h) Family
i) No one
j) Other…. Please explain:
If you answered (i) “No one”, please explain your reasons for this:
32. Have you received/used any of the following? (Please select all that
apply)
a) Medical diagnosis
b) Prescription Medication
c) Over-the-counter medication
d) Aids / supports: tubi-grip/strapping, hand/wrist splint; back belt; walking
stick etc.
e) Therapeutic treatment, e.g. physiotherapy, osteopathy, chiropractic
treatment, acupuncture, Alexander Technique
f) Relaxation methods and related exercises, e.g. Yoga. Pilates, Tai Chi
g) Relaxation techniques, e.g. meditation, aromatherapy
h) Sports and related exercise, e.g. swimming, gym, step class
33. Has your workstation furniture (e.g. chair, desk) been adapted in any
way to help with your symptoms?
a) Yes
b) No
If you answered (a) “Yes”, please explain what changes have been
made, how they came about and if they have been of any help

34. Has your computer equipment (e.g. monitor, keyboard, pointing device,
software) been changed in any way to help with your symptoms?
a) Yes
b) No
If you answered (a) “Yes”, please explain what changes have been
made, how they came about and if they have been of any help
Please go to Section 3 (Designing For User Need) – found on page 13

SECTION 3: Designing For User Need
With recent advances in technology it is now possible for computers to

monitor the user’s work habits, activities, posture and/or changes to the
user’s emotional state and react accordingly, e.g. if the user appears to be
tired or experiencing stress then the computer might suggest that a break
is taken or if the user has adopted a poor posture for longer than a few
minutes then the computer might suggest alternative postures which are
less likely to result in discomfort or that the user conducts gentle
stretching exercises.
This section of the survey considers such technology.
NOTE: Questions 35, 36, and 37 appear to be the same, but they are not.
In turn, they ask you to consider whether you would “welcome”,
“tolerate” or “reject” the monitoring methods described
35. Would you WELCOME any of the following detection methods?

a) Keyboard use (e.g. key action (force/pressure used), position of keyboard
on work surface)
b) Pointing device use (e.g. hand/finger pressure on device, grip position,
button action (force/pressure used) speed and range of movement,
position of device on work surface)
c) Head position in relation to monitor (e.g. distance from screen)
d) Seated position (e.g. fully in chair with back supported, perched, fidgeting)
e) Upper body posture (e.g. leaning towards the screen, leaning to one side)
f) Facial expression (e.g. frowning, eyebrow positions)
g) Eye size (e.g. changes can indicate mood)
h) Eye gaze (e.g. rapid movement, lack of movement, tracking eye gaze
across screen)
i) Voice monitoring, e.g. detecting the volume of your speech, tone, words
used etc.
j) None
COMMENT:
36. Would you TOLERATE any of the following detection methods?

on work surface)

across screen)
used etc.
j) None
COMMENT:
37. Would you REJECT (refuse to use) any of the following detection
methods (Please select all that apply)
on work surface)
across screen)
used etc.
j) None
Please explain your reasons for rejecting this method (s) and then go to
Question 39:
38. From those methods which you would either WELCOME or TOLERATE,
which detection method would you find MOST acceptable?
(Please select just ONE)
on work surface)
across screen)
used etc.
Please explain your reasons for selecting this method (s):

39. Can you think of any other detection methods which you would
welcome or tolerate which have not been listed above?
a) Yes
b) No
If you answered (a) “Yes”, please describe the method here:
40. If you have rejected all of the monitoring methods listed in Question 37,
please explain your reasons for this:
YOU HAVE REACHED THE END OF THE SURVEY.

THANK YOU FOR YOUR TIME
The next stage of this research project involves interviews with selected
survey participants
 Ideally, to facilitate observation of the participant at her/his workstation,
interviews will take place at the participant‟s place of work. If a workplace
interview is not possible, then the location will be of the participant‟s choosing
 The interviews will take place during July and the early part of August (no
later than the Bank Holiday weekend) and will be arranged to suit each
participant‟s availability
Would you be willing to take part in the interview stage of this project?
a) Yes
b) No
c) Undecided
COMMENTS:
If you wish to, please use the space below to provide any additional
thoughts / comments you may have on the topics raised by this survey, or
on the survey itself…….

Appendix_3
Interview Participant Informed Consent Form
NOTE:
For the purposes of the study this form was printed with smaller
margins. As a result, the text and line spacing were not as cramped
as they appear here.

Informed Consent Form for Participants in Research Studies
(This form is to be completed independently by the participant after reading the Information Sheet
and/or having listened to an explanation about the research.)
Title of Does attitude affect risk? Potential for user acceptance

Project: of interactive affect and ergonomic monitoring systems
This study has been approved by the UCL Research

Ethics Committee [Project ID Number]: MSc/0809/018
Participant’s Statement:
I ……………………………………………………(please print your name here)
agree that (please cross through those points which you do not agree with / consent to)
 I have read the information sheet and/or the project has been explained to
me orally;
 I have had the opportunity to ask questions and discuss the study/project;
 I have received satisfactory answers to all my questions or have been
advised of an individual to contact for answers to pertinent questions about
the research and my rights as a participant and whom to contact in the event
of a research-related problem;
 I understand that the information I submit during the survey and/or interview
process may be published in the study report and that, on request, I will be sent a
copy. Confidentiality and anonymity will be maintained and it will not be possible
to identify me from any publications;
 I consent to the information I provide being digitally recorded (audio) and used for
the purposes of the study, i.e. transcription, analysis and use within the report;
 Where they exist, I consent to existing digital photographs of me at my
workstation being used for the purposes of this study, i.e. for analysis and
comparison purposes. Photographs which include facial images will be edited so
that it will not be possible to identify me;
workstation being published in the study report. Photographs which include facial
images will be edited so that it will not be possible to identify me;
workstation being used for post-study purposes, e.g. publication in journals,
reports, conferences. Photographs which include facial images will be edited so
that it will not be possible to identify me;
 I consent to the information I submit being used for post-study purposes, e.g.
publication in journals, reports, conferences;
 I understand that I am free to withdraw from the study at any time;
 I consent to the processing of my personal information for the purposes of this
study only and that it will not be used for any other purpose. I understand that
such information will be treated as strictly confidential and handled in accordance
with the provisions of the Data Protection Act 1998.
Signed: Date:
Investigator’s Statement:
I, Jan Mulligan, confirm that I have carefully explained the purpose of the study to the
participant and outlined any reasonably foreseeable risks or benefits (where applicable).
Signed: Date:

Appendix_4
Example Questions for Semi-structured Interviews

Interview: Example Questions
“If the computer could warn you that your

working habits, posture, and/or emotional
state might be putting you at risk of
developing or aggravating symptoms, e.g.
stress, headaches, eyestrain, physical
discomfort, would you want it to and, if so,
what monitoring methods would you find
acceptable?”
Taking into account the statement shown above, please consider the example
questions based on your experience of using computers in a workplace setting
and your attitude to related risk. The questions are designed to act as a guide
for the interview, not to restrict it. Some of the questions appear to ask for yes/no
responses or that you make a selection from a list of choices. I do, however,
hope to elicit more information from you based on your thoughts on the topics
and reasons for your responses. I also hope that we may explore other areas of
interest as they emerge from our discussion.
Participation:
 Before the interview starts you will be given the opportunity to ask any
questions that you may have and you will be asked to sign a consent form
which I will bring with me (a copy of the form will be sent to you, for
references purposes, ahead of the session).
 Please be assured that outside of the correspondence between us your
confidentiality and anonymity will be maintained; it will not be possible to
identify you from any publications.
 You are free to skip any question(s) which you do not wish to answer or to
stop the interview at any time; there is no need to give a reason.
 Should we not have time to complete the interview within the allocated time
then, with your agreement, we may complete the interview through
subsequent email or telephone contact.

Jan Mulligan
Tel: XXXX XXXXXXX


EXAMPLE QUESTIONS
A) Symptoms:
1. If you experience symptoms whilst working (or as a result of working), e.g.
stress, headaches, eyestrain, physical discomfort, how/what does that
make you feel? Please select all that apply:
Annoyed Comforted Horrified Impatient Thoughtful
Uneasy Guilty Sceptical Worried Ineffectual
Relaxed Proud Indifferent Apologetic Depressed
Bored Amused Decisive Sympathetic Grateful
Upset Irritated Dispirited Sad Despondent
Regretful Preoccupied Alarmed Relieved Playful
Encouraged Disappointed Justified Doubtful Impatient
Pensive Reassured Happy Anxious Angry
Confused Fear Rage Flustered Excited
Despair Satisfaction Disgust Defiant Shame
Surprised Joyful Curious Weak Frustrated
Inefficient Supported Compromised Rested Contempt
Other, please explain…..
2. Do your symptoms impact on your life outside of work? If “yes”, how does
that make you feel?
B) Strategies:
1. What coping strategies, other than technical adaptations, have you tried /
do you currently use?
2. Have they been / are they: more, less or equally beneficial than the
technical adaptations?
3. How do you measure the success of a strategy?
C) If you decide to take a work or rest break away from your computer,
how/what does that make you feel? Please select all that apply:

D) Interactive Affect and Ergonomic Monitoring System:
1. What would you expect/want the system to do?
2. What would you not expect/want the system to do?
3. What benefit(s), if any, would you expect/want such a system to provide
above and beyond those provided by your existing strategies?
E) System feedback timing / frequency:

1. When would you want the system to notify you that there might be a
problem? e.g.
 every time it notices something
 periodically (e.g. once an hour)
 at predetermined times of day (e.g. you chose set times throughout
the day)
 when you log off
 on demand (only when you ask it to)
 variable (you adjust the settings to suit your work pattern, symptom
levels etc.)
 other…..
F) System feedback methods: Please see IMAGE sheet for examples of the
options……
1. Which of the following would you accept (welcome, tolerate, prefer) or
reject and why:
a) On-screen text messages
b) Option a, with animated cartoon-style character
c) Option a, with drawing/sketch support
d) Option a, with animated drawing/sketch support
e) Option a, with virtual assistant support
f) Option a, with animated/video-based virtual assistant support
g) Your choice from options a-f, plus natural voice audio
h) Your choice from options a-f, plus computer-generated audio
i) Natural voice audio only (no on-screen text)
j) Computer-generated audio message only (no on-screen text)
k) Other, please explain……

G) If the system advised you to take a work or rest break away from your
computer, how/what would that make you feel? Please select all that
apply:
H) System data storage:

1. Would you want the system to save a recording of:
- what it monitors
- what it detects
- what it recommends
2. If you answered “yes” to any of the previous options:

a) how often would you expect/want the system to save a recording, e.g.
every few minutes, on an hourly basis / daily basis, per event etc.
b) how long would you expect/want the system to save the recording(s)
for, e.g. permanently (stored until it is manually deleted), stored for a
set period of time and then automatically deleted etc.
c) in what format would you expect/want the information to be
saved/stored, e.g. open access plain text, MS Word or Excel file /
password protection plain text, MS Word or Excel file / open access
encrypted file (only readable through the system‟s software) /
password protected encrypted file (only readable through the system‟s
software) / other…..
I) Privacy:
1. In principle, would use of an interactive affect and ergonomic monitoring
system give you cause for concern about your privacy? Please explain…

2. With the choice of monitoring methods discussed in the survey (shown
below), which, if any, give(s) you cause for concern with regards to your
privacy and why?
a) Keyboard use (e.g. key action (force/pressure used), position of
keyboard on work surface, number of presses)
button action (force/pressure used, number of presses), speed and
range of movement, position of device on work surface)
d) Seated position (e.g. fully in chair with back supported, perched,
fidgeting)
e) Upper body posture (e.g. leaning towards the screen, leaning to one
side)
across screen)
i) Voice monitoring, e.g. detecting the volume of your speech, tone,
words used etc.
j) None
J) Trust (in the system):
Example definition of trust:

“reliance on the integrity, strength, ability, surety, etc.,
of a person or thing; confidence”
1. What, if any, trust issues do you perceive there to be with regards to

Interactive Affect and Ergonomic Monitoring Systems. An example might
be the system‟s ability to accurately detect that you do have a problem,
rather than reporting false negatives, e.g. a frown might be as a result of
non-work thought (e.g. trying to remember something that you need to
buy on the way home etc.) rather than frustration with the computer or
your work.

2. Please rank the identified monitoring methods in terms of trust, where “1”
is the method you would trust most and “9” is the method you would trust
least:
NOTE: please consider that the method you would trust most may not
be the same as the method which you would prefer to use
Keyboard use
(e.g. key action (force/pressure used), position of keyboard on work
surface, number of presses)
Pointing device use

(e.g. hand/finger pressure on device, grip position, button action
(force/pressure used, number of presses), speed and range of
movement, position of device on work surface)
Head position in relation to monitor

(e.g. distance from screen)
Seated position
(e.g. fully in chair with back supported, perched, fidgeting)
Upper body posture

(e.g. leaning towards the screen, leaning to one side)
Facial expression
(e.g. frowning, eyebrow positions)
Eye size
(e.g. changes can indicate mood)
Eye gaze
(e.g. rapid movement, lack of movement, tracking eye gaze across
screen)
Voice monitoring
(e.g. detecting the volume of your speech, tone, words used etc)
COMMENTS on your ranking choices…….

K) Trust (in your employer):
1. Would you be happy to know that your employer (or your employer‟s
representatives) could have access to the system‟s monitoring, detection
and/or recommendation records?
2. If your answer is “no”, please explain why not / what concerns do you
have?
3. If your answer is “yes”, how would you expect/want your employer to use
that information? Do you believe that the information would be used in
that way? If not, why not? Please explain:
L) Do you think that your responses to the survey or the questions posed
today:
1. Have been influenced by anything? Example reasons might include:
 existing or historic symptoms
 previous experience of monitoring systems (e.g. direct exposure,
witnessing someone else using one, anecdotal)
 your work location
 the industry you work in
 your employer
 other....
2. Would change if you were considering your personal computer use, i.e.
home-based / non-work computer use? If “yes”, why, how?

Image Sheet
Examples of text-based messages
Examples of animated cartoon-style Text-based message with

characters example of drawing/sketch
Text-based message with examples of animated characters
Text-based message with example of virtual assistant support

NOTE: image may be static, animated or video-based

Appendix_5
Contact Sheet of Photographs Used During Interviews
NOTE:
During the interviews larger versions of the images were shown to
the participant (one image at a time).

Interview: Photograph Sheets
“If the computer could warn you that your

working habits, posture, and/or emotional
state might be putting you at risk of
developing or aggravating symptoms, e.g.
stress, headaches, eyestrain, physical
discomfort, would you want it to and, if so,
what monitoring methods would you find
acceptable?”
Please consider the following photographs and explain your instant

reaction to each photograph, i.e. how the picture makes you feel
emotionally and/or physically.

Jan Mulligan
Tel: XXXX XXXXXXX


Photograph_1 Photograph_2 Photograph_3
Photograph_13

Appendix_6
Survey Comments

Appendix_6a:
Survey Question 20, “Does your company provide you with Display Screen
Equipment (DSE) Workstation Assessments?”
Despite responding “yes” to, some participants qualified their responses:
P17(F) “We put some health and safety policies in place and I go through
basic workstation assessments with every new employee – but don‟t
think it is a formal DSE as such”
P18(F) “Only people who have/develop problems might get offered one”
P25(F) “But it is only paper based unless requested”
Whilst others, reported never having an assessment:
P7(F) “Have not had one”

(time in current job is reported as being “more than two years”)
P26(F) “I don‟t know that I have ever had a DSE – I had never heard of it till
this moment.”
(time in current job is reported as being “between 6 and 12 months in
role, but with the employer for over 12 years”)
P29(M) “Never”
(time in current job is reported as being “more than one year”)
P36(F) “Never had one”

(time in current job is reported as being “more than one year”)
Appendix_6b:
Survey Question 31, “Have you discussed your symptoms with....”
P2(F): “Comes sporadically so haven't thought to mention it”
P26(F): “I see it a symptom of physical inactivity and I just need to do some

serious moving around, go for a walk or something”
P30(F): “Not entirely sure of the cause, but think it‟s the way I sit and use my
right arm”
P34(M): “It wears off overnight so assume as not too serious I think”

Appendix_6c:
Survey Question 39: “Can you think of any other detection methods which
you would welcome or tolerate which have not been listed above?”
P1(F): “Quantity of a particular computer-based action. E.g. “you‟ve clicked

the mouse 350 times in the last hour, it‟s time you did something else
before your hand seizes up” – or similar!”
P9(F): “Something on the monitor that reminds me to move/switch position”
P12(F): “To monitor the effect on eyes tension”
P18(F): “I would like to be reminded to take a break from using the mouse
when a particular job requires a lot of mousing”
P25(F): “Some way of looking at the type of work being done, e.g. intense
focus of a spreadsheet is a bit different from reading your emails”
P29(M): “Monitor position in relation to head”
P32(M): “Simply telling you how long you have been at the keyboard /
computer”
Appendix_6d:
Final Comments:
P7(F): “In many cases, I feel the computer user is probably aware of what
causes pain, etc. and could probably help themselves! However,
some employers are not always in a rush to provide an audit, or other
equip to alleviate symptoms”
P13(F): “I suppose my main issue with such computer use is the amount of
strain on the eyes but I was not sure if this could be monitored through
the „Eye size‟ or „eye gaze‟ part of monitoring..... “.
P17(F): “I think this could be really useful, but I have a sort of horror vision of
my computer turning into my Mum and nagging me to sit up straight,
smile, be polite, etc. which I found deeply irritating and rather
patronising even when I was a child! It could be quite fun if it was a bit
ironic with warnings and danger levels – “risk of pain level 5 occurring
in 10 minutes” – like something off ER or in a submarine”
P18(F): “A lot of people where I work are only using computers to put in info, or
collate data and most of them have had no training whatsoever, and
no idea that the way they are sitting, keyboarding or mousing cause
aches they might be experiencing....”.

P20(F): “I think employers would be unlikely to welcome/tolerate many of these
suggestions”
P23(M): “Depending on the proposed detection methods used (e.g.

photographic evidence of poor posture, or lack of pressure in a chair
backrest indicating that the user is not sitting back into chair) may be
construed by some users as “Big Brother”. However, those with
symptoms may welcome the intervention. Prevention versus Cure”
P26(F): “My husband works writing software which enables, for example,
teachers to see what their students have got going on their screens
etc, and also enables employers to see what employees are doing on
their desktops or networked laptops. Its nickname is „master-and-
slave‟ and there‟s something not quite all right about computers
keeping such a close eye on us. I think I would rather learn to spot my
own physical stillness and get moving”

Appendix_7
Interview Participants’ Trust Ranking of Example CIMS

Systems


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DOES ATTITUDE AFFECT RISK?

An Investigation into the Potential for User Acceptance of

NOTE BY THE UNIVERSITY

This project report is submitted as an examination paper. No responsibility can be

Last, but by no means least, my profound thanks go to VCS whose unwavering

Despite high numbers of UK workers experiencing work-related musculoskeletal

The study investigates work-based computer users‟ attitudes towards

By understanding what acceptance means to potential users, employers and

Chapter Description Page

1.1 The Nature of Work Related Musculoskeletal 1

1.2 Management of MSDs 5

1.3 The Study 8

2.1 Stage 1 (Survey) 14

2.2 Stage 2 (Interviews) 16

3 Analysis and Findings 19

3.1 Stage 1 (Survey) 19

3.2 Stage 2 (Interview) 24

4.1 Ethics in Persuasive Technology 36

4.6 Self (the “user”) 43

4.7. The CIMS User Acceptance Model 44

4.8 Study Limitations 48

4.9. Future Studies 49

Figure_1 A conceptual framework of the possible roles and 3

Figure_2 Overview of Captology 9

Figure_3 Tension Taker (Ultrasis) 10

Figure_4 Word Grid used for Interview Questions A1, C and G 17

Figure_5 Response distribution for Survey Question 27: 21

Figure_6 Response distribution for Survey Question 28: 21

Figure_7 Response distribution for Survey Questions 35, 36 and 23

Figure_8 Word cloud depicting dominance of responses to IQ-A1: 25

Figure_9 Convergence of ethics, persuasion and technology 36

Figure_10 CIMS User Acceptance Model 47

Figure_11 Persuasive Technology User Acceptance Variables 50

Table_1 Primary DSE Regulations 5

Table_2 Definition of a DSE Workstation 5

Table_3 Example Break Reminder Software Utilities 12

Table_4 Example Computer-based Interactive Monitoring Systems 15

Table_5 Phases of Thematic Analysis 18

Table_6 Abbreviation Conventions Used in Paper 18

Table_7 Demographic Characteristics: gender, age, industry 19

Table_8 Analysis of feedback from Survey Question 14: “What 20

Table_9 Ranked positions for Survey Question 29: 22

Table_10 Ranked positions for the Survey Question 38: “From 24

Table_11 Themes and Sub-themes Identified From Interview 27

Table_12 Trust Ranking Positions for Example Monitoring Systems 29

Table_13 Stage of Change Model Definitions 45

Table_14 Examples of readiness states for CIMS 45

Table_15 Components of the CIMS User Acceptance Model 47

Appendix_1 Invitation to Participate in Research Project Survey 64

Appendix_2 MSc Human Computer Interaction Research Project 66

Appendix_3 Interview Participant Informed Consent Form 84

Appendix_4 Example Questions for Semi-structured Interview 86

Appendix_5 Contact Sheet of Photographs Used During Interviews 96

Appendix_6 Survey Comments 100

Appendix_7 Interview Participants‟ Trust Ranking of Example 104

“…. certain morbid affections gradually arise….. from some

This chapter introduces the reader to musculoskeletal disorders, their causes

1.1 The Nature of Work Related Musculoskeletal Disorders

As Ramazzini (1713a) observed, work-related ill health may be multidimensional

1.1.1 Defining MSDs

J. E. Mulligan MSc HCI-E Thesis Page 1

1.1.2 Risk Factors

Conceptual frameworks developed by the National Research Council illustrate

1.1.3 Physical Factors